Provider Demographics
NPI:1376603076
Name:ROSEN, CHARLOTTE H (LPC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:H
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 NALL AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1620
Mailing Address - Country:US
Mailing Address - Phone:913-963-1795
Mailing Address - Fax:913-469-9779
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:STE 103
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1620
Practice Address - Country:US
Practice Address - Phone:913-963-1795
Practice Address - Fax:913-469-9779
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC126101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6270496OtherUNITED BEHAVIORAL HEALTH
KS32355011OtherBCBS OF KANSAS CITY