Provider Demographics
NPI:1003184987
Name:ROSS, MARI ANTOINETTE (PHD, LPC-MHSP)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:ANTOINETTE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 HUNT CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6036
Mailing Address - Country:US
Mailing Address - Phone:615-400-2504
Mailing Address - Fax:615-447-1065
Practice Address - Street 1:133 INDIAN LAKE RD STE 204
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3883
Practice Address - Country:US
Practice Address - Phone:615-338-6341
Practice Address - Fax:615-338-6342
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2022-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2768101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)