Provider Demographics
NPI:1306465752
Name:ROSE, TESS EMILY (LCSW)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:EMILY
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11271 DEXTER CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2739
Mailing Address - Country:US
Mailing Address - Phone:720-853-0800
Mailing Address - Fax:
Practice Address - Street 1:11271 DEXTER CIR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233
Practice Address - Country:US
Practice Address - Phone:720-853-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668421041C0700X, 104100000X
COCSW.099272121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker