Provider Demographics
NPI:1679221626
Name:ROSE, DARREN V (MA, LMHCA)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:V
Last Name:ROSE
Suffix:
Gender:M
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 E CRANDALL CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6110
Mailing Address - Country:US
Mailing Address - Phone:509-204-1636
Mailing Address - Fax:
Practice Address - Street 1:3707 E CRANDALL CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6110
Practice Address - Country:US
Practice Address - Phone:509-204-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61183063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61183063OtherWASHINGTON STATE DEPT. OF HEALTH