Healthcare Provider Details

I. General information

NPI: 1033051743
Provider Name (Legal Business Name): ROSE SMITH PROFESSIONAL CLINICAL COUNSELOR PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 4TH ST
YREKA CA
96097-2911
US

IV. Provider business mailing address

208 4TH ST
YREKA CA
96097-2911
US

V. Phone/Fax

Practice location:
  • Phone: 530-643-9189
  • Fax:
Mailing address:
  • Phone: 530-643-9189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROSE MARY SMITH
Title or Position: OWER
Credential: LPCC
Phone: 530-643-9189