Provider Demographics
NPI:1942458856
Name:ROSS, ALYSIA S (MS, LMHC, MAC, DVC)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, LMHC, MAC, DVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 EAST BAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2207
Mailing Address - Country:US
Mailing Address - Phone:727-582-8000
Mailing Address - Fax:727-587-7924
Practice Address - Street 1:1661 EAST BAY DRIVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2207
Practice Address - Country:US
Practice Address - Phone:727-582-8000
Practice Address - Fax:727-587-7924
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health