Active NPI
Lisa A Rose, LPC
- Professional Counselor
- Kennett, MO
National Provider Identifier
1710163365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2006038844
- Practice address
- 925 Highway V V
Kennett, MO 63857-7707 - Phone
- (573) 888-5925
- Fax
- (573) 888-9365
- NPI assigned
- Jan 14, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2006038844 | MO | Primary |
Addresses
Primary practice location
925 Highway V V
Kennett, MO 63857-7707
Mailing address
3001 Warrior LN
Poplar Bluff, MO 63901-8685
Phone (573) 686-1200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710163365 | Medicaid | MO | |
| 17101063365 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006038844 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375747200000",
"number": "1710163365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 WARRIOR LN",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639018685",
"telephone_number": "573-686-1200",
"fax_number": "573-686-1029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 HIGHWAY V V",
"city": "KENNETT",
"state": "MO",
"postal_code": "638577707",
"telephone_number": "573-888-5925",
"fax_number": "573-888-9365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "LISA",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-14",
"last_updated": "2013-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2006038844",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710163365",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "17101063365",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennett, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.