Healthcare Provider Details

I. General information

NPI: 1043135114
Provider Name (Legal Business Name): TOBA ROSEN LLMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 S TELEGRAPH RD
BLOOMFIELD HILLS MI
48302-0180
US

IV. Provider business mailing address

5587 SHAUN RD
WEST BLOOMFIELD MI
48322-1619
US

V. Phone/Fax

Practice location:
  • Phone: 248-256-5209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4151001231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: