Provider Demographics
NPI:1124796198
Name:THOMAS ROSIEK, PEGGY (LPC)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:THOMAS ROSIEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-1858
Mailing Address - Country:US
Mailing Address - Phone:903-748-1777
Mailing Address - Fax:
Practice Address - Street 1:22 PIERCE RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-1858
Practice Address - Country:US
Practice Address - Phone:903-748-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional