Individual
ROSE MESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1745 POCATELLO CREEK RD, POCATELLO, ID 83201-2308
(208) 233-9383
(208) 233-2707
Mailing address
1745 POCATELLO CREEK RD, POCATELLO, ID 83201-2308
(208) 233-9383
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT 4384
ID
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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