Provider Demographics
NPI:1144587999
Name:ROSE, SONYA SEVERSON (LMHC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:SEVERSON
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:MRS
Other - First Name:SONYA
Other - Middle Name:ROSE
Other - Last Name:SEVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LMFT
Mailing Address - Street 1:1707 E. 36TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-4041
Mailing Address - Country:US
Mailing Address - Phone:509-624-0090
Mailing Address - Fax:
Practice Address - Street 1:1707 E. 36TH AVENUE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-4041
Practice Address - Country:US
Practice Address - Phone:509-624-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006414101YM0800X
WALF00001303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAROSS2131821318OtherPREMERA BLUE CROSS