Provider Demographics
NPI:1174977599
Name:ROSE, WHITNEY (LCSW)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KASOTA CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1257
Mailing Address - Country:US
Mailing Address - Phone:406-672-5004
Mailing Address - Fax:406-830-3156
Practice Address - Street 1:1211 S RESERVE ST STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3103
Practice Address - Country:US
Practice Address - Phone:406-327-3057
Practice Address - Fax:406-327-3231
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-168791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical