Provider Demographics
NPI:1750922266
Name:BECKLEY, ROSS ALAN (LLP)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:ALAN
Last Name:BECKLEY
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6182 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5008
Mailing Address - Country:US
Mailing Address - Phone:586-291-9744
Mailing Address - Fax:
Practice Address - Street 1:8344 HALL RD STE 209
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5554
Practice Address - Country:US
Practice Address - Phone:586-286-5870
Practice Address - Fax:586-286-5834
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist