Provider Demographics
NPI:1659576734
Name:MOSTERT, ROSELYN MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROSELYN
Middle Name:MARIE
Last Name:MOSTERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ROSELYN
Other - Middle Name:M
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2526
Mailing Address - Country:US
Mailing Address - Phone:417-347-7579
Mailing Address - Fax:
Practice Address - Street 1:1905 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1529
Practice Address - Country:US
Practice Address - Phone:417-347-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004028159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1659576734Medicaid