Provider Demographics
NPI:1053658930
Name:ROSE, ANDREW NEWKIRK (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:NEWKIRK
Last Name:ROSE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1177 FOURMILE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9743
Mailing Address - Country:US
Mailing Address - Phone:303-532-6780
Mailing Address - Fax:303-225-2708
Practice Address - Street 1:3434 47TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1880
Practice Address - Country:US
Practice Address - Phone:303-225-2708
Practice Address - Fax:303-225-2708
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional