Organization
SOUTHERN ROSE PSYCHOTHERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MEGAN ROSE LARSON MSW, LCSW (THERAPIST)
(971) 334-1940
Entity
Organization
Contact information
Practice address
555 JEFFERSON ST STE 301, PADUCAH, KY 42001-1088
(971) 334-1940
Mailing address
2780 NEW HOLT RD STE D373, PADUCAH, KY 42001-7441
(971) 334-1940
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407393150
—
OR
Enumeration date
03/11/2022
Last updated
03/11/2022
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