Individual
DOUGLAS ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
507 E 18TH ST, CHEYENNE, WY 82001-4617
(307) 637-7906
(307) 635-3965
Mailing address
507 E 18TH ST, CHEYENNE, WY 82001-4617
(307) 637-7906
(307) 635-3965
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAP-028
WY
Other
Enumeration date
09/21/2010
Last updated
09/21/2010
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