Provider Demographics
NPI:1265071484
Name:ROSE, HAROLD BERNARD III (LCSW)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:BERNARD
Last Name:ROSE
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1600 W MAUD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4726
Mailing Address - Country:US
Mailing Address - Phone:573-840-0615
Mailing Address - Fax:573-872-4797
Practice Address - Street 1:1600 W MAUD ST STE 2
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4726
Practice Address - Country:US
Practice Address - Phone:573-840-0615
Practice Address - Fax:573-872-4797
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MO20180260621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health