Provider Demographics
NPI:1841370608
Name:ROSE, GARY A
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 NE 80TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-1139
Mailing Address - Country:US
Mailing Address - Phone:360-546-5252
Mailing Address - Fax:360-905-1738
Practice Address - Street 1:1603 E 4TH PLAIN BLVD (V3VI)
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-696-4061
Practice Address - Fax:360-905-1738
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor