MEDICARE: ROSE SMITH PROFESSIONAL CLINICAL COUNSELOR PROFESSIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033051743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE SMITH PROFESSIONAL CLINICAL COUNSELOR PROFESSIONAL

Provider Business Mailing Address
First Line	:	208 4TH ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-2911
Country	:	US
Telephone Number	:	530-643-9189
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 4TH ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-2911
Country	:	US
Telephone Number	:	530-643-9189
Fax Number	:

Authorized Official
Title or Position	:	OWER
Name	:	ROSE MARY SMITH
Credential	:	LPCC
Telephone Number	:	530-643-9189

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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