Provider Demographics
NPI:1942557632
Name:ROSE, JARED S (LPCC-S, NCC, EMDR)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:S
Last Name:ROSE
Suffix:
Gender:M
Credentials:LPCC-S, NCC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 S REYNOLDS RD STE B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7411
Mailing Address - Country:US
Mailing Address - Phone:419-410-1830
Mailing Address - Fax:419-754-2510
Practice Address - Street 1:1351 S REYNOLDS RD STE B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7411
Practice Address - Country:US
Practice Address - Phone:419-410-1830
Practice Address - Fax:419-754-2510
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100184101YM0800X
OHE.1100184-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.1100184OtherOHIO COUNSELOR, SOCIAL WORKER, MARRIAGE & FAMILY THERAPIST BOARD
OH0220898Medicaid