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General NPI Number Information
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NPI Number | 1669848586
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Entity Type | Organization
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Legal Business Name | TERRI L ROSS
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 416 HERITAGE PL
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City | FARIBAULT
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State | MN
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Zip | 55021-5248
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Country | US
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Telephone | 507-330-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 416 HERITAGE PL
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City | FARIBAULT
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State | MN
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Zip | 55021-5248
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Country | US
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Telephone | 507-330-4688
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TERRI L ROSS
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Credential | LMFT
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Telephone | 507-330-4688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1731
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License Number State | MN
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