Provider Demographics
NPI:1962883876
Name:MALLORY C ROSE
Entity type:Organization
Organization Name:MALLORY C ROSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:214-402-7500
Mailing Address - Street 1:3305 ROBINCREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5126
Mailing Address - Country:US
Mailing Address - Phone:214-402-7500
Mailing Address - Fax:
Practice Address - Street 1:3305 ROBINCREST DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5126
Practice Address - Country:US
Practice Address - Phone:214-402-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty