Provider Demographics
NPI:1588867659
Name:PERRETZ-ROSALES, ROBERT (MA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PERRETZ-ROSALES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 GULL HARBOR RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-2872
Mailing Address - Country:US
Mailing Address - Phone:360-352-0303
Mailing Address - Fax:360-352-2513
Practice Address - Street 1:3102 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-352-0303
Practice Address - Fax:360-352-2513
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health