Provider Demographics
NPI:1760775944
Name:ELIZABETH A. ROSE PHD, PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:ELIZABETH A. ROSE PHD, PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:810-964-5901
Mailing Address - Street 1:2015 COLCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4631
Mailing Address - Country:US
Mailing Address - Phone:810-964-5901
Mailing Address - Fax:
Practice Address - Street 1:12765 S. SAGINAW STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2449
Practice Address - Country:US
Practice Address - Phone:810-695-1900
Practice Address - Fax:810-695-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty