Provider Demographics
NPI:1972835163
Name:ROSS, JENNIFER CALLOWAY (MA, MFT, LADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CALLOWAY
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, MFT, LADC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CALLOWAY
Other - Last Name:DUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:691 SIERRA ROSE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4000
Mailing Address - Country:US
Mailing Address - Phone:775-825-2503
Mailing Address - Fax:775-825-2509
Practice Address - Street 1:691 SIERRA ROSE DR
Practice Address - Street 2:SUITE B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4000
Practice Address - Country:US
Practice Address - Phone:775-825-2503
Practice Address - Fax:775-825-2509
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01198106H00000X
NV01505101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)