MEDICARE: MS. ROZLYN REEVES ROSS LLPC

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	101YM0800X	Mental Health Counselor	6401011623	MI

General Provider Information

NPI Number	:	1841513587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROZLYN REEVES ROSS LLPC

Provider Business Mailing Address
First Line	:	100 W MAIN ST
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-3606
Country	:	US
Telephone Number	:	616-456-1443
Fax Number	:	616-732-6392

Provider Business Practice Location Address
First Line	:	100 W MAIN ST
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-3606
Country	:	US
Telephone Number	:	616-456-1443
Fax Number	:	616-732-6392

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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