Individual
MIRANDA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 885-4264
(219) 886-1332
Mailing address
361 N GRAND BLVD, GARY, IN 46403-1942
(662) 820-6514
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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