Provider Demographics
NPI:1770679300
Name:ROSS, KC (MFT)
Entity Type:Individual
Prefix:MS
First Name:KC
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:COLE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:PAPAIKOU
Mailing Address - State:HI
Mailing Address - Zip Code:96781
Mailing Address - Country:US
Mailing Address - Phone:808-964-3000
Mailing Address - Fax:808-964-3000
Practice Address - Street 1:260 KAMEHAMEHA AVE. #215
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-964-3000
Practice Address - Fax:808-964-3000
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-16101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional