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General NPI Number Information
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NPI Number | 1679884951
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Entity Type | Individual
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Provider Name | PHILLIP ROBERT ROSS L.L.P.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 8600 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48202-2142
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Country | US
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Telephone | 313-875-7601
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Fax | 313-875-7622
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Provider Business Mailing Address
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Address Line | 472 ARDMORE DR
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City | FERNDALE
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State | MI
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Zip | 48220-2817
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Country | US
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Telephone | 313-247-8813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301007911
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License Number State | MI
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