MEDICARE: JESSIE UNGOLADV ROSE LPC-CANDIDATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		OK
2	101Y00000X	Counselor		OK

General Provider Information

NPI Number	:	1750223871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE UNGOLADV ROSE LPC-CANDIDATE

Provider Business Mailing Address
First Line	:	1902 W 45TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-6830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 S SHERIDAN RD STE 509
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-5719
Country	:	US
Telephone Number	:	918-370-6329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ JESSIE UNGOLADV ROSE LPC-CANDIDATE” Practice Location

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