Provider Demographics
NPI:1144696279
Name:ROSS, JESSICA (LLPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
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 1:5360 MARSH VIEW CT APT 122
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5275
Mailing Address - Country:US
Mailing Address - Phone:313-918-6740
Mailing Address - Fax:
Practice Address - Street 1:5360 MARSH VIEW CT APT 122
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5275
Practice Address - Country:US
Practice Address - Phone:313-918-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health