Doctor Name: | TIM ROSS |
NPI Number: | 1003260845 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | LCS20247 |
Business Practice Address: | 710 Bella Vista Dr Morro Bay, CA - 934422417 |
Business Phone Number: | 8054585601 |
Business Fax Number: | |
Mailing Address: | 710 Bella Vista Dr, MORRO BAY |
State: | CA |
Postal Code: | 934422417 |
Phone Number: | 8054585601 |
Fax Number: | |
NPI Enumeration Date: | 04/18/2016 |
NPI Last Update Date: | 04/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCS20247 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |