Healthcare Provider Details

I. General information

NPI: 1386804854
Provider Name (Legal Business Name): MARGARET ROSE FURNISS LCSW, LMFT, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEGGY ROSE FURNISS M.A.

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 S WEBSTER ST
KOKOMO IN
46902-6911
US

IV. Provider business mailing address

4065 S WEBSTER ST
KOKOMO IN
46902-6911
US

V. Phone/Fax

Practice location:
  • Phone: 765-437-2253
  • Fax: 765-319-0522
Mailing address:
  • Phone: 765-437-2253
  • Fax: 765-319-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002144A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001008A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: