Healthcare Provider Details

I. General information

NPI: 1649375999
Provider Name (Legal Business Name): BARBARA JILL ROSSEN ACSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 NORTHWIND DR SUITE 110
EAST LANSING MI
48823-5092
US

IV. Provider business mailing address

PO BOX 2257
CHESTERTON IN
46304-0357
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-7050
  • Fax: 517-332-7552
Mailing address:
  • Phone: 219-926-8320
  • Fax: 219-926-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801013805
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: