Provider Demographics
NPI:1730454117
Name:ROSEN, MICHAEL ALAN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:ROSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S PLEASANT GROVE BLVD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2161
Mailing Address - Country:US
Mailing Address - Phone:801-637-5118
Mailing Address - Fax:
Practice Address - Street 1:151 S PLEASANT GROVE BLVD
Practice Address - Street 2:UNIT 3
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2161
Practice Address - Country:US
Practice Address - Phone:801-637-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)