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General NPI Number Information
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NPI Number | 1316429459
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Entity Type | Individual
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Provider Name | CARLY ROSENBECK MC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 955 CONGRESS PARK DR
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City | CENTERVILLE
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State | OH
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Zip | 45459-4009
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Country | US
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Telephone | 937-907-1437
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Fax |
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Provider Business Mailing Address
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Address Line | 7905 SCHATZ POINTE DR STE 104
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City | CENTERVILLE
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State | OH
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Zip | 45459-3856
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Country | US
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Telephone | 937-952-6379
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2204525
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2404640
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License Number State | OH
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