Active NPI
Rose Health Foundation
- Clinical Psychologist
- Wichita, KS
National Provider Identifier
1629808043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Legal business name
- ROSE HEALTH FOUNDATION
- Practice address
- 4925 S Broadway Ave # 1309
Wichita, KS 67216-3716 - Phone
- (817) 290-3200
- NPI assigned
- Aug 2, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Michael S Moates, ED.D.
- Title
- Executive Director
- Phone
- (817) 290-9500
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Pastoral Counselor | 101YP1600X | |||
| Professional Counselor | 101YP2500X | |||
| Clinical Neuropsychologist | 103G00000X | |||
| Psychologist | 103T00000X | |||
| Clinical Psychologist | 103TC0700X | Primary | ||
| Counseling Psychologist | 103TC1900X | |||
| Forensic Psychologist | 103TF0200X | |||
| Naturopath | 175F00000X | |||
| Homeopath | 175L00000X |
Addresses
Primary practice location
4925 S Broadway Ave # 1309
Wichita, KS 67216-3716
Mailing address
4925 S Broadway Ave # 1309
Wichita, KS 67216-3716
Other names 1
- Rose Health
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722556800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1722556800000",
"number": "1629808043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4925 S BROADWAY AVE # 1309",
"city": "WICHITA",
"state": "KS",
"postal_code": "672163716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4925 S BROADWAY AVE # 1309",
"city": "WICHITA",
"state": "KS",
"postal_code": "672163716",
"telephone_number": "817-290-3200"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROSE HEALTH FOUNDATION",
"organizational_subpart": "NO",
"enumeration_date": "2024-08-02",
"last_updated": "2024-08-02",
"certification_date": "2024-08-02",
"status": "A",
"authorized_official_last_name": "MOATES",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "817-290-9500",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "ED.D."
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP1600X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Pastoral",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Clinical Neuropsychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Forensic",
"state": null,
"license": null,
"primary": false
},
{
"code": "175F00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Naturopath",
"state": null,
"license": null,
"primary": false
},
{
"code": "175L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Homeopath",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Rose Health",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.