Provider Demographics
NPI:1457872681
Name:ROSADO, JENNYFER A (LCMHC, LPC)
Entity type:Individual
Prefix:
First Name:JENNYFER
Middle Name:A
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LCMHC, LPC
Other - Prefix:
Other - First Name:JENNYFER
Other - Middle Name:A
Other - Last Name:BRUNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 8TH ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-3322
Mailing Address - Country:US
Mailing Address - Phone:940-386-9234
Mailing Address - Fax:
Practice Address - Street 1:813 8TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3322
Practice Address - Country:US
Practice Address - Phone:940-386-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1253101YM0800X
TX81937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3109112Medicaid