Provider Demographics
NPI:1841513587
Name:ROSS, ROZLYN REEVES (LLPC)
Entity type:Individual
Prefix:MS
First Name:ROZLYN
Middle Name:REEVES
Last Name:ROSS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3606
Mailing Address - Country:US
Mailing Address - Phone:616-456-1443
Mailing Address - Fax:616-732-6392
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3606
Practice Address - Country:US
Practice Address - Phone:616-456-1443
Practice Address - Fax:616-732-6392
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health