Provider Demographics
NPI:1043522071
Name:ROSE, JULIE ANN (MA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 THRUSHGILL LN APT 10305
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6647
Mailing Address - Country:US
Mailing Address - Phone:631-662-5197
Mailing Address - Fax:
Practice Address - Street 1:10000 THRUSHGILL LN APT 10305
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6647
Practice Address - Country:US
Practice Address - Phone:631-662-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health