MEDICARE: MR. KEVIN MICHAEL ROSS M.S., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC44268	CA

General Provider Information

NPI Number	:	1346474475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN MICHAEL ROSS M.S., LMFT

Provider Business Mailing Address
First Line	:	7257 BEVERLY BLVD STE 108
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2567
Country	:	US
Telephone Number	:	323-412-0785
Fax Number	:

Provider Business Practice Location Address
First Line	:	7257 BEVERLY BLVD STE 108
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2567
Country	:	US
Telephone Number	:	323-412-0785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	10/18/2018

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