Provider Demographics
NPI:1336207729
Name:ROSS, DENISE LYNN (MFT 28063)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:MFT 28063
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 CORTE SONRISA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9341
Mailing Address - Country:US
Mailing Address - Phone:760-761-8310
Mailing Address - Fax:
Practice Address - Street 1:3426 CORTE SONRISA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-9341
Practice Address - Country:US
Practice Address - Phone:760-761-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT 28063OtherCA MFT LICENSE