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General NPI Number Information
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NPI Number | 1942557632
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Entity Type | Individual
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Provider Name | JARED S ROSE LPCC-S, NCC, EMDR
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Gender | Male
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Dates
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Enumeration Date | 08/13/2012
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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 |
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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 | 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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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.1100184-SUPV
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License Number State | OH
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