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General NPI Number Information
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NPI Number | 1427832690
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Entity Type | Organization
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Legal Business Name | THE ROSES LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 330 3RD ST S
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City | VIRGINIA
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State | MN
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Zip | 55792-2632
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Country | US
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Telephone | 218-639-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 521 16TH AVE W
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City | EVELETH
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State | MN
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Zip | 55734-1171
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Country | US
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Telephone | 218-639-5510
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA M LEADERS
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Credential | LMFT
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Telephone | 218-639-5510
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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 |
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License Number State |
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