Doctor Name: | MRS. JESSICA ROSS |
NPI Number: | 1144696279 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLPC |
License Number: | 6401014994 |
Business Practice Address: | 5360 Marsh View Ct Apt 122 Shelby Township, MI - 483165275 |
Business Phone Number: | 3139186740 |
Business Fax Number: | |
Mailing Address: | 5360 Marsh View Ct Apt 122, SHELBY TOWNSHIP |
State: | MI |
Postal Code: | 483165275 |
Phone Number: | 3139186740 |
Fax Number: | |
NPI Enumeration Date: | 08/12/2015 |
NPI Last Update Date: | 08/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401014994 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |