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General NPI Number Information
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NPI Number | 1871135202
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Entity Type | Individual
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Provider Name | JENNIFER I ROSS LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 931 E MAIN STREET
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City | CECILIA
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State | KY
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Zip | 42724-7614
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Country | US
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Telephone | 844-435-0900
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Fax | 270-858-4029
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Provider Business Mailing Address
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Address Line | PO BOX 1080
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City | BURKESVILLE
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State | KY
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Zip | 42717-1080
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Country | US
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Telephone | 270-858-6655
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Fax | 270-858-4027
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 271867
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License Number State | KY
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