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NPI Code Detail

MEDICARE: MRS. KATHRYN ELAINE ROSS M.A.

MEDICARE: MRS. KATHRYN ELAINE ROSS M.A.
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
1106H00000XMarriage & Family TherapistIMF 52946CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11639366446OTHERCANPI

General Provider Information

NPI Number : 1639366446
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHRYN ELAINE ROSS M.A.
Provider Business Mailing Address
First Line : PO BOX 950
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-0950
Country : US
Telephone Number : 530-529-9454
Fax Number : 530-529-9456
Provider Business Practice Location Address
First Line : 590 ANTELOPE BLVD STE 40A
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-2477
Country : US
Telephone Number : 530-529-9454
Fax Number : 530-529-9456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2007
Last Update Date : 06/28/2021

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