Provider Demographics
NPI:1669286050
Name:ROSE, SASHELLE P (MSED, LMHCA)
Entity type:Individual
Prefix:
First Name:SASHELLE
Middle Name:P
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 SWEET WOOD CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-8125
Mailing Address - Country:US
Mailing Address - Phone:260-440-6417
Mailing Address - Fax:
Practice Address - Street 1:4150 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1208
Practice Address - Country:US
Practice Address - Phone:877-594-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002494A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health