MEDICARE: MR. LARRY EDWIN ROSS L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1753	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568510097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY EDWIN ROSS L.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 5177
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85010-5177
Country	:	US
Telephone Number	:	602-344-5651
Fax Number	:	602-344-5578

Provider Business Practice Location Address
First Line	:	1144 E MCDOWELL RD
Second Line	:	SUITE 301
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2664
Country	:	US
Telephone Number	:	602-344-5651
Fax Number	:	602-344-5578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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