Provider Demographics
NPI:1528286515
Name:ROSE, CYNTHIA HEATHER (LMFT, CACIII)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:HEATHER
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMFT, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:
Practice Address - Street 1:1023 COUNTY ROAD 610
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-887-2179
Practice Address - Fax:970-887-9311
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO843106H00000X
NY000063106H00000X
CO7201101YA0400X
CA44437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)