Individual
MS. LISA A ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
925 HIGHWAY V V, KENNETT, MO 63857-7707
(573) 888-5925
(573) 888-9365
Mailing address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
(573) 686-1029
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2006038844
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17101063365
—
MO
05
—
1710163365
—
MO
Enumeration date
01/14/2008
Last updated
08/06/2013
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