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General NPI Number Information
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NPI Number | 1851700280
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Entity Type | Individual
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Provider Name | TINA MARIE ROSE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 1115 ELKTON DR STE 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3597
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Country | US
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Telephone | 719-357-6471
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Fax | 719-434-9811
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Provider Business Mailing Address
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Address Line | 3400 WOODCOCK ST APT O4
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City | BERTHOUD
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State | CO
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Zip | 80513-7030
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Country | US
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Telephone | 970-689-6843
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0004324
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7190
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License Number State | OH
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