Provider Demographics
NPI:1699840058
Name:ROSS HALPERN
Entity Type:Organization
Organization Name:ROSS HALPERN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-222-6046
Mailing Address - Street 1:3520 GREEN CT
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1566
Mailing Address - Country:US
Mailing Address - Phone:734-222-6046
Mailing Address - Fax:734-222-3639
Practice Address - Street 1:3520 GREEN CT
Practice Address - Street 2:SUITE 185
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1566
Practice Address - Country:US
Practice Address - Phone:734-222-6046
Practice Address - Fax:734-222-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRH008342103T00000X
MILT0703461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N92550Medicare ID - Type Unspecified
MIS42678Medicare UPIN
MI0N92560Medicare ID - Type Unspecified