Provider Demographics
NPI:1306915442
Name:ROSE, WILLIAM OSCAR (LP, LMFT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:OSCAR
Last Name:ROSE
Suffix:
Gender:M
Credentials:LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18530 29TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1525
Mailing Address - Country:US
Mailing Address - Phone:763-745-3484
Mailing Address - Fax:
Practice Address - Street 1:155 COUNTY ROAD 24
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-9614
Practice Address - Country:US
Practice Address - Phone:763-745-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0380103TC0700X
MN0082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist