Provider Demographics
NPI:1386961035
Name:ROSE, ANDREW M (MFT INTERN)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:ROSE
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 E THOMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2918
Mailing Address - Country:US
Mailing Address - Phone:805-643-1446
Mailing Address - Fax:
Practice Address - Street 1:856 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2918
Practice Address - Country:US
Practice Address - Phone:805-643-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health