Provider Demographics
NPI:1417457946
Name:MOOSE COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:MOOSE COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROFESSIONAL CLINICAL COUNSEL
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, NCC, EMDRC
Authorized Official - Phone:419-410-1830
Mailing Address - Street 1:1351 S REYNOLDS RD STE B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7411
Mailing Address - Country:US
Mailing Address - Phone:419-410-1830
Mailing Address - Fax:419-754-2510
Practice Address - Street 1:1351 S REYNOLDS RD STE B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7411
Practice Address - Country:US
Practice Address - Phone:419-410-1830
Practice Address - Fax:419-754-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0220898Medicaid
OHE.111100184OtherOHIO COUNSELOR, SOCIAL WORKER, MARRIAGE & FAMILY THERAPIST BOARD