Provider Demographics
NPI:1417387903
Name:ROSS BEHAVIORAL GROUP, PLLC
Entity Type:Organization
Organization Name:ROSS BEHAVIORAL GROUP, PLLC
Other - Org Name:THE ROSS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:615-338-6341
Mailing Address - Street 1:133 INDIAN LAKE RD
Mailing Address - Street 2:STE 204
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3883
Mailing Address - Country:US
Mailing Address - Phone:615-338-6341
Mailing Address - Fax:615-338-6342
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10000002768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5224021-00Medicaid
TNQ009156Medicaid