Provider Demographics
NPI:1518261056
Name:ROSE, MICHAEL (MA, CPHQ, CPHRM)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ROSE
Suffix:
Gender:M
Credentials:MA, CPHQ, CPHRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 NE 169TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1256 NE 169TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5934
Practice Address - Country:US
Practice Address - Phone:303-903-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-25
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL608101YA0400X
FLMT000906106H00000X
CO509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)