Provider Demographics
NPI:1518026640
Name:ROSE, KATHY JO (MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:JO
Last Name:ROSE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9965 SCRIPPS WESTVIEW WAY UNIT 35
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2482
Mailing Address - Country:US
Mailing Address - Phone:858-356-8243
Mailing Address - Fax:
Practice Address - Street 1:9965 SCRIPPS WESTVIEW WAY UNIT 35
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2482
Practice Address - Country:US
Practice Address - Phone:858-356-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA21805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist