Healthcare Provider Details

I. General information

NPI: 1790283406
Provider Name (Legal Business Name): DALE K. ROSE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 08/11/2025
Certification Date:
Deactivation Date: 01/30/2018
Reactivation Date: 08/11/2025

III. Provider practice location address

12725 VENTURA BLVD STE K
STUDIO CITY CA
91604-2437
US

IV. Provider business mailing address

12725 VENTURA BLVD STE K
STUDIO CITY CA
91604-2437
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-1283
  • Fax:
Mailing address:
  • Phone: 818-783-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC36408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: