Healthcare Provider Details

I. General information

NPI: 1760879191
Provider Name (Legal Business Name): ROSE M MYLOTT LADC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHARTER HILL DR
RUTLAND VT
05701-3750
US

IV. Provider business mailing address

14 CHARTER HILL DR
RUTLAND VT
05701-3750
US

V. Phone/Fax

Practice location:
  • Phone: 802-768-1279
  • Fax:
Mailing address:
  • Phone: 802-768-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000618
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0120531
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: