Provider Demographics
NPI:1336795947
Name:KASRAI, ROSE MANLEY (LMFT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MANLEY
Last Name:KASRAI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CANEBRAKE BLVD STE 110-057
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-2211
Mailing Address - Country:US
Mailing Address - Phone:601-345-1627
Mailing Address - Fax:
Practice Address - Street 1:10 CANEBRAKE BLVD STE 110-057
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-2211
Practice Address - Country:US
Practice Address - Phone:601-345-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist