Provider Demographics
NPI:1952809436
Name:DALE K. ROSE, LMFT, INC., CSAT
Entity Type:Organization
Organization Name:DALE K. ROSE, LMFT, INC., CSAT
Other - Org Name:DALE K. ROSE, LMFT, INC., A MARRIAGE AND FAMILY THERAPIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-783-1283
Mailing Address - Street 1:12725 VENTURA BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2437
Mailing Address - Country:US
Mailing Address - Phone:818-783-1283
Mailing Address - Fax:818-783-7673
Practice Address - Street 1:12725 VENTURA BLVD STE K
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2437
Practice Address - Country:US
Practice Address - Phone:818-783-1283
Practice Address - Fax:818-783-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty