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NPI Code Detail

MEDICARE: MRS. MARY ROSE MOU

MEDICARE: MRS. MARY ROSE MOU
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 Counselor21818NC
2101YP2500XProfessional Counselor4906CA
3106H00000XMarriage & Family Therapist2620TN
4106H00000XMarriage & Family Therapist104993CA

General Provider Information

NPI Number : 1760822951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ROSE MOU
Provider Business Mailing Address
First Line : 210 25TH AVE N STE 1220
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1640
Country : US
Telephone Number : 802-393-4567
Fax Number :
Provider Business Practice Location Address
First Line : 210 25TH AVE N STE 1220
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1640
Country : US
Telephone Number : 802-393-4567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2013
Last Update Date : 08/06/2025

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Directions to “ MRS. MARY ROSE MOU ” Practice Location

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