Andrew Justin Baker Rose, CSAC, QMHP-A, LAC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

125 S Main Cross St
Louisa, KY 41230-1065

Phone

(606) 638-0938

Fax

(859) 813-5394

NPI assigned

Dec 7, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1770098139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S MAIN CROSS ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301065",
            "telephone_number": "606-638-0938",
            "fax_number": "859-813-5394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S MAIN CROSS ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301065",
            "telephone_number": "606-638-0938",
            "fax_number": "859-813-5394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 Virginia Ave NE Ste 104",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "242731539",
            "country_code": "US",
            "telephone_number": "276-821-2442",
            "fax_number": "276-821-2442",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "135 Whitetail Rdg",
            "address_purpose": "LOCATION",
            "city": "Clintwood",
            "state": "VA",
            "postal_code": "242286186",
            "country_code": "US",
            "telephone_number": "276-821-2442",
            "fax_number": "276-821-2442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSE",
        "first_name": "ANDREW",
        "middle_name": "JUSTIN BAKER",
        "name_prefix": "Mr.",
        "credential": "CSAC, QMHP-A, LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-07",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "175461",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "86000431A",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0710103608",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0732008841",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cody Roberts
• Edward Shane Roberts, PSS
• Matthew Oaks Robison, CADC
• Paul Travis Roe, PSS
• Sarah Beth Rogers, LPCC
• Lance Diamond Rose, PSS
• Eden Adair Ross, TCM
• Dawn Rowe, LPCC-S
• Tracy Rowland, APRN
• Tara Runyon

• Case Manager/Care Coordinator in Louisa, KY
• Providers in Louisa, KY by specialty
• Case Manager/Care Coordinator in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.