Provider Demographics
NPI:1750701751
Name:ROSE, BARBARA (MA, CADC III, MAC)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA, CADC III, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15675 SW BEVERLY BEACH CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5025
Mailing Address - Country:US
Mailing Address - Phone:503-407-1703
Mailing Address - Fax:
Practice Address - Street 1:12555 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0546
Practice Address - Country:US
Practice Address - Phone:503-407-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-R-22101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)