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General NPI Number Information
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NPI Number | 1417457946
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Entity Type | Organization
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Legal Business Name | MOOSE COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 1351 S REYNOLDS RD STE B
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City | TOLEDO
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State | OH
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Zip | 43615-7411
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Country | US
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Telephone | 419-410-1830
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Fax | 419-754-2510
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Provider Business Mailing Address
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Address Line | 1351 S REYNOLDS RD STE B
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City | TOLEDO
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State | OH
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Zip | 43615-7411
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Country | US
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Telephone | 419-410-1830
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Fax | 419-754-2510
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Authorized Official
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Title or Position | OWNER/PROFESSIONAL CLINICAL COUNSEL
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Name | DR. JARED S. ROSE
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Credential | LPCC-S, NCC, EMDRC
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Telephone | 419-410-1830
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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 | E.1100184
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License Number State | OH
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