| Southern Rose Psychotherapy, Llc | |
|
555 Jefferson St Ste 301 Paducah KY 42001-1088 | |
| (971) 334-1940 | |
| Not Available |
| Full Name | Southern Rose Psychotherapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 555 Jefferson St Ste 301, Paducah, Kentucky |
| Authorized Official Name and Position | Megan Rose Larson (THERAPIST) |
| Authorized Official Contact | 9713341940 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Rose Psychotherapy, Llc 2780 New Holt Rd Ste D373 Paducah KY 42001-7441 Ph: (971) 334-1940 | Southern Rose Psychotherapy, Llc 555 Jefferson St Ste 301 Paducah KY 42001-1088 Ph: (971) 334-1940 |
| NPI Number | 1962150615 |
|---|---|
| Provider Enumeration Date | 03/11/2022 |
| Last Update Date | 03/11/2022 |
| Certification Date | 03/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962150615 | NPI | - | NPPES |
| 1407393150 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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