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General NPI Number Information
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NPI Number | 1285409391
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Entity Type | Organization
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Legal Business Name | ROSE PSYCHOTHERAPY
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 16204 HIGHWAY 7
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City | MINNETONKA
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State | MN
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Zip | 55345-3405
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Country | US
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Telephone | 612-293-8564
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Fax |
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Provider Business Mailing Address
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Address Line | 7771 157TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55124-6362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CALLIE ROSE
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Credential |
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Telephone | 612-293-8564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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