Provider Demographics
NPI:1124268354
Name:HARRIET, ROSE M (LPC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:HARRIET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1712
Mailing Address - Country:US
Mailing Address - Phone:307-217-2161
Mailing Address - Fax:307-201-0442
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1846
Practice Address - Country:US
Practice Address - Phone:307-217-2161
Practice Address - Fax:307-201-0442
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY807101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator