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General NPI Number Information
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NPI Number | 1487264529
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Entity Type | Individual
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Provider Name | TERRI LYNN ROSE LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 1701 LAKE LANSING RD STE 120
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City | LANSING
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State | MI
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Zip | 48912-3798
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Country | US
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Telephone | 810-494-7180
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Fax | 810-715-1334
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Provider Business Mailing Address
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Address Line | 133 WESTOWN DR NW APT 302
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-3715
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3824
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License Number State | FL
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