Provider Demographics
NPI:1851900500
Name:ROSE, SEASON MARIE
Entity Type:Individual
Prefix:
First Name:SEASON
Middle Name:MARIE
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1608
Mailing Address - Country:US
Mailing Address - Phone:260-244-0264
Mailing Address - Fax:
Practice Address - Street 1:360 N OAK ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1608
Practice Address - Country:US
Practice Address - Phone:260-244-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor