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NPI Code Detail

MEDICARE: MS. STEPHANEE JOY ROSE L.M.H.C.

MEDICARE: MS. STEPHANEE JOY ROSE L.M.H.C.
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
1101YM0800XMental Health CounselorMH-4599FL

General Provider Information

NPI Number : 1114085032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STEPHANEE JOY ROSE L.M.H.C.
Provider Business Mailing Address
First Line : 5535 COMMUNITY OAKS CT
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-7883
Country : US
Telephone Number : 904-448-4700
Fax Number : 904-448-4717
Provider Business Practice Location Address
First Line : 5776 SAINT AUGUSTINE RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8030
Country : US
Telephone Number : 904-448-4700
Fax Number : 904-448-4717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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