| Doctor Name: | MRS. BETTYJO ROSE |
| NPI Number: | 1740313493 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MALLPCAC1 |
| License Number: | 6301006553 |
| Business Practice Address: | 2633 S Lapeer Rd Orion, MI - 483602810 |
| Business Phone Number: | 2483935555 |
| Business Fax Number: | 2483931791 |
| Mailing Address: | 2633 S Lapeer Rd, ORION |
| State: | MI |
| Postal Code: | 483602810 |
| Phone Number: | 2483935555 |
| Fax Number: | 2483931791 |
| NPI Enumeration Date: | 03/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301006553 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |