Healthcare Provider Details

I. General information

NPI: 1538688833
Provider Name (Legal Business Name): ROSE FREUND MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2522
US

IV. Provider business mailing address

19262 E FRONT BLVD NE
EAST BETHEL MN
55092-8523
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-7964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2468502
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1587
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: