Provider Demographics
NPI:1871250530
Name:ROSE, NATASHA (MS)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 DARBY CREEK RD STE 39A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1671
Mailing Address - Country:US
Mailing Address - Phone:606-776-6185
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD STE 39A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1671
Practice Address - Country:US
Practice Address - Phone:606-776-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY302825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370915481007Medicaid