=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114559556
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON RENEE ROSSI LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2020
-----------------------------------------------------
Last Update Date | 02/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E RUSSELL RD STE A&B
-----------------------------------------------------
City | TECUMSEH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49286-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-366-5030
-----------------------------------------------------
Fax | 517-366-5034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 SEAGATE STE 800
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43604-1558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-585-1964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401008836
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------