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General NPI Number Information
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NPI Number | 1306915442
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Entity Type | Individual
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Provider Name | WILLIAM OSCAR ROSE LP, LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 155 COUNTY ROAD 24
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City | WAYZATA
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State | MN
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Zip | 55391-9614
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Country | US
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Telephone | 763-745-3484
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Fax |
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Provider Business Mailing Address
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Address Line | 18530 29TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55447-1525
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Country | US
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Telephone | 763-745-3484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP0380
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0082
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License Number State | MN
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