Basic Information
| Provider Information | |||||||||
| NPI: | 1174096325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACLEOD | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | KIMBERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1455 DIXON AVE | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800268879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034438500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1455 DIXON AVE | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800268879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034438500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2019 | ||||||||
| LastUpdateDate: | 11/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60928614 | CO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | CG60928614 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 0014058 | CO | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.