Provider Demographics
NPI:1689030231
Name:OLIVER ROSS PSYCHOLOGY AND CONSULTING
Entity Type:Organization
Organization Name:OLIVER ROSS PSYCHOLOGY AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:612-275-4193
Mailing Address - Street 1:1595 SELBY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6285
Mailing Address - Country:US
Mailing Address - Phone:612-504-2315
Mailing Address - Fax:
Practice Address - Street 1:1595 SELBY AVE STE 112
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6285
Practice Address - Country:US
Practice Address - Phone:612-504-2315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty