# SOUTHERN ROSE PSYCHOTHERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962150615
- **Authorized official:** MRS. MEGAN ROSE LARSON MSW, LCSW (THERAPIST)
- **Authorized official phone:** (971) 334-1940

## Contact information

- **Practice address:** 555 JEFFERSON ST STE 301, PADUCAH, KY 42001-1088
- **Practice address phone:** (971) 334-1940
- **Mailing address:** 2780 NEW HOLT RD STE D373, PADUCAH, KY 42001-7441
- **Mailing address phone:** (971) 334-1940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 03/11/2022
- **Last updated:** 03/11/2022