Individual
MARY ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LPC CACII
Contact information
Practice address
709 3RD AVE, LONGMONT, CO 80501-5926
(720) 340-2710
Mailing address
PO BOX 1301, LONGMONT, CO 80502-1301
(720) 340-2710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11721
CO
Other
Enumeration date
08/04/2014
Last updated
08/04/2014
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