Healthcare Provider Details

I. General information

NPI: 1023149838
Provider Name (Legal Business Name): ALICIA ROSS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 AQUEDUCT DR
PLACENTIA CA
92870-5467
US

IV. Provider business mailing address

244 AQUEDUCT DR
PLACENTIA CA
92870-5467
US

V. Phone/Fax

Practice location:
  • Phone: 714-222-3423
  • Fax:
Mailing address:
  • Phone: 714-222-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number40829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: