Provider Demographics
NPI:1710547898
Name:ROSE, KATHRYN (LPC NCC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2632
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-2632
Mailing Address - Country:US
Mailing Address - Phone:907-982-4044
Mailing Address - Fax:
Practice Address - Street 1:307 E NORTHERN LIGHTS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2701
Practice Address - Country:US
Practice Address - Phone:907-229-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK134475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional