Doctor Name: | MS. MIKA M ROSS |
NPI Number: | 1609171248 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED. |
License Number: | 2006036094 |
Business Practice Address: | 614 Autumnwood Forest Dr Lake Saint Louis, MO - 633672633 |
Business Phone Number: | 3143682958 |
Business Fax Number: | |
Mailing Address: | 614 Autumnwood Forest Dr, LAKE SAINT LOUIS |
State: | MO |
Postal Code: | 633672633 |
Phone Number: | 3143682958 |
Fax Number: | |
NPI Enumeration Date: | 01/12/2011 |
NPI Last Update Date: | 01/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2006036094 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |