Healthcare Provider Details

I. General information

NPI: 1184257917
Provider Name (Legal Business Name): JUSTIN BRENT ROSE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

IV. Provider business mailing address

30184 MARQUETTE AVE
WESLEY CHAPEL FL
33545-4485
US

V. Phone/Fax

Practice location:
  • Phone: 931-273-7446
  • Fax:
Mailing address:
  • Phone: 931-273-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17932
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC10814
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: