Healthcare Provider Details

I. General information

NPI: 1780453142
Provider Name (Legal Business Name): PHYLLIS ROSS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CAMERON ST
MONROE LA
71201-3714
US

IV. Provider business mailing address

2900 CAMERON ST
MONROE LA
71201-3714
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-9995
  • Fax:
Mailing address:
  • Phone: 318-323-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17834
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: