Provider Demographics
NPI:1568656528
Name:ROSS, MICHELLE A (MA,LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:P.O. BOX 336
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1136
Mailing Address - Country:US
Mailing Address - Phone:231-924-7837
Mailing Address - Fax:231-924-9140
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1136
Practice Address - Country:US
Practice Address - Phone:231-924-7837
Practice Address - Fax:231-924-9140
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI64010001049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional