Provider Demographics
NPI:1699847467
Name:ROSE, MICHAEL DAVID (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:ROSE
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2118
Mailing Address - Country:US
Mailing Address - Phone:303-917-9748
Mailing Address - Fax:
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 309
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-917-9748
Practice Address - Fax:303-758-9203
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional