Healthcare Provider Details

I. General information

NPI: 1316577182
Provider Name (Legal Business Name): TORY D ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E ST UNIT B
DAVIS CA
95616-4523
US

IV. Provider business mailing address

6933 WOODMORE OAKS DR
ORANGEVALE CA
95662-2934
US

V. Phone/Fax

Practice location:
  • Phone: 530-206-9996
  • Fax:
Mailing address:
  • Phone: 209-480-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number45537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: