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General NPI Number Information
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NPI Number | 1326499815
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Entity Type | Organization
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Legal Business Name | ALICIA ROSE LLC
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Dates
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Enumeration Date | 06/26/2016
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Last Update Date | 06/26/2016
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Provider Practice Location Address
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Address Line | 1716 E 30TH AVE SUITE B
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City | HUTCHINSON
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State | KS
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Zip | 67502-1230
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Country | US
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Telephone | 888-406-5778
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 E 30TH AVE SUITE B
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City | HUTCHINSON
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State | KS
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Zip | 67502-1230
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Country | US
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Telephone | 888-406-5778
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | ALICIA ROSE
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Credential | LSCSW, LAC
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Telephone | 620-664-8391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4317
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License Number State | KS
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