Healthcare Provider Details

I. General information

NPI: 1174530596
Provider Name (Legal Business Name): ANDREW L. ROSS M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 W DOVE CENTRE RD
MARANA AZ
85658-5063
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-1445
  • Fax: 520-616-1446
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-616-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-10294
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: