Provider Demographics
NPI:1598381998
Name:ROSS, CAROLYN M
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:CARRUTHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1321 MURFREESBORO PIKE STE 702
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2679
Mailing Address - Country:US
Mailing Address - Phone:844-359-7641
Mailing Address - Fax:615-577-5654
Practice Address - Street 1:1609 N DIXIE AVE STE 114
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7494
Practice Address - Country:US
Practice Address - Phone:270-702-4641
Practice Address - Fax:615-577-5654
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician