Doctor Name: | JANNA L. CLARK ROSELIUS |
NPI Number: | 1003185497 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC |
License Number: | 2009017630 |
Business Practice Address: | 13311 State Route H Saint James, MO - 655598879 |
Business Phone Number: | 5736994172 |
Business Fax Number: | |
Mailing Address: | 13311 State Route H, SAINT JAMES |
State: | MO |
Postal Code: | 655598879 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/14/2011 |
NPI Last Update Date: | 12/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2009017630 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |