Provider Demographics
NPI:1033605639
Name:ROSE, ALLYSON MAY (LPCC, LADC)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:MAY
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:MAY
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC LADC
Mailing Address - Street 1:900 LONG LAKE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 LONG LAKE RD STE 215
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6428
Practice Address - Country:US
Practice Address - Phone:651-900-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2178101YM0800X
MN305094101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)