MEDICARE: ROSE GROVE COUNSELING LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205764842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE GROVE COUNSELING LLC

Provider Business Mailing Address
First Line	:	5534 SAINT JOE RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3328
Country	:	US
Telephone Number	:	812-302-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2458 N COUNTY ROAD 1000 E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-9017
Country	:	US
Telephone Number	:	317-474-4464
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	REBEKAH ROSE
Credential	:	LCSW
Telephone Number	:	812-302-3203

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/25/2026

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