Provider Demographics
NPI:1487790440
Name:ROSE, WILLOW ANN (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:WILLOW
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:WILLOW
Other - Middle Name:ANN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:1255 PEARL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3570
Mailing Address - Country:US
Mailing Address - Phone:541-687-6983
Mailing Address - Fax:
Practice Address - Street 1:71 E 15TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4005
Practice Address - Country:US
Practice Address - Phone:541-461-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC C1524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional