Individual
CARLY ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA, THW-YSS, CPC
Contact information
Practice address
2411 MARTIN LUTHER KING JR BLVD, EUGENE, OR 97401-5824
(541) 603-6965
(541) 682-3276
Mailing address
2411 MARTIN LUTHER KING JR BLVD, EUGENE, OR 97401-5824
(541) 603-6965
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
21-QMHA-R-1845
OR
Other
Enumeration date
03/23/2017
Last updated
06/15/2023
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