Healthcare Provider Details

I. General information

NPI: 1285977959
Provider Name (Legal Business Name): ZACHARY L ROSS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR SUITE 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

2120 S MCCLINTOCK DR SUITE 105
TEMPE AZ
85282-2692
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-302-7884
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-302-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLMSW-13565
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-15350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: