Healthcare Provider Details

I. General information

NPI: 1225744022
Provider Name (Legal Business Name): MICHAEL ROSE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38100 COLORADO AVE
AVON OH
44011-1031
US

IV. Provider business mailing address

8761 LINCOLNSHIRE BLVD
STRONGSVILLE OH
44149-1149
US

V. Phone/Fax

Practice location:
  • Phone: 440-961-1008
  • Fax:
Mailing address:
  • Phone: 440-876-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2405771
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: