Provider Demographics
NPI:1790283406
Name:ROSE, DALE K (LMFT)
Entity type:Individual
Prefix:MS
First Name:DALE
Middle Name:K
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 VENTURA BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2437
Mailing Address - Country:US
Mailing Address - Phone:818-783-1283
Mailing Address - Fax:
Practice Address - Street 1:12725 VENTURA BLVD STE K
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2437
Practice Address - Country:US
Practice Address - Phone:818-783-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2025-08-11
Deactivation Date:2018-01-30
Deactivation Code:
Reactivation Date:2025-08-11
Provider Licenses
StateLicense IDTaxonomies
CAMFC36408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist