Provider Demographics
NPI:1316395809
Name:ROSS, MADISON
Entity Type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3305
Mailing Address - Country:US
Mailing Address - Phone:870-234-2600
Mailing Address - Fax:870-234-2606
Practice Address - Street 1:301 BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3305
Practice Address - Country:US
Practice Address - Phone:870-234-2600
Practice Address - Fax:870-234-2606
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health