Provider Demographics
NPI:1922518638
Name:ROSS, ANN MARIE (TEMPARARY LMHC)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:TEMPARARY LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 STATE HIGHWAY 48
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-5092
Mailing Address - Country:US
Mailing Address - Phone:712-370-4578
Mailing Address - Fax:
Practice Address - Street 1:1308 STATE HIGHWAY 48
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-5092
Practice Address - Country:US
Practice Address - Phone:712-370-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty