Healthcare Provider Details

I. General information

NPI: 1205764842
Provider Name (Legal Business Name): ROSE GROVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 25TH ST
COLUMBUS IN
47201-4387
US

IV. Provider business mailing address

5534 SAINT JOE RD
FORT WAYNE IN
46835-3328
US

V. Phone/Fax

Practice location:
  • Phone: 812-302-3203
  • Fax:
Mailing address:
  • Phone: 812-302-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH ROSE
Title or Position: THERAPIST
Credential: LCSW
Phone: 812-302-3203