Provider Demographics
NPI:1912064908
Name:DAVIDSON, ROSS WILLIAM (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:WILLIAM
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EUBANK BLVD NE
Mailing Address - Street 2:SUITE D-2B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2759
Mailing Address - Country:US
Mailing Address - Phone:505-363-8280
Mailing Address - Fax:
Practice Address - Street 1:201 EUBANK BLVD NE
Practice Address - Street 2:SUITE D-2B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2759
Practice Address - Country:US
Practice Address - Phone:505-363-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201034829OtherPRESBYTERIAN
NM06789OtherLOVELACE