Provider Demographics
NPI:1679884951
Name:ROSS, PHILLIP ROBERT (LLP)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ROBERT
Last Name:ROSS
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 ARDMORE DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2817
Mailing Address - Country:US
Mailing Address - Phone:313-247-8813
Mailing Address - Fax:
Practice Address - Street 1:8600 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2142
Practice Address - Country:US
Practice Address - Phone:313-875-7601
Practice Address - Fax:313-875-7622
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007911103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist