Healthcare Provider Details

I. General information

NPI: 1588796551
Provider Name (Legal Business Name): YVONNE ROSEBRAUGH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W STATE ST STE A-14
MUSCLE SHOALS AL
35661-2861
US

IV. Provider business mailing address

PO BOX 2091
MUSCLE SHOALS AL
35662-2091
US

V. Phone/Fax

Practice location:
  • Phone: 256-856-8580
  • Fax: 256-330-4603
Mailing address:
  • Phone: 256-856-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4956C
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19347
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: