Provider Demographics
NPI:1992130751
Name:ROSE, KRISTEN E (LPC, LIMHP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:E
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPC, LIMHP
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:E
Other - Last Name:BUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:809 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6722
Mailing Address - Country:US
Mailing Address - Phone:402-699-0954
Mailing Address - Fax:
Practice Address - Street 1:1000 POLE CREEK CROSSING
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162
Practice Address - Country:US
Practice Address - Phone:308-254-5825
Practice Address - Fax:910-858-0111
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional