Provider Demographics
NPI:1346365384
Name:ROSE-MATHESON, TINA (MA, ED, PCC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ROSE-MATHESON
Suffix:
Gender:F
Credentials:MA, ED, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 PIGEON RUN RD SW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-9612
Mailing Address - Country:US
Mailing Address - Phone:330-305-1668
Mailing Address - Fax:
Practice Address - Street 1:6465 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8412
Practice Address - Country:US
Practice Address - Phone:330-305-1668
Practice Address - Fax:330-305-1696
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004230101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional