Individual
JERRY ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
825 N WACO AVE, WICHITA, KS 67203-3939
(316) 201-6047
Mailing address
825 N WACO AVE, WICHITA, KS 67203-3939
(316) 201-6074
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC04019
KS
Other
Enumeration date
02/24/2022
Last updated
02/24/2022
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