Provider Information for 1801287248
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DOUG ROSE LPC
Other Names:Professional Name:ROBERT DOUG ROSE LPCSex: Male
NPI: 1801287248
Last Updated: 2015-02-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1801287248 | ||||||||
| Enumeration Date | 2015-02-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 9 QUITMAN, LA 71268-0009 United States Phone: 318-439-1399 | Fax:855-334-8166 | ||||||||
| Primary Practice Address | 2545 HIGHWAY 4 JONESBORO, LA 71251-6909 United States Phone: 318-439-1399 | Fax:855-334-8166 | ||||||||
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