Provider Demographics
NPI:1114323177
Name:ROSS LARRIVY, ALEX ELIZABETH (MS, LPCC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:ELIZABETH
Last Name:ROSS LARRIVY
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 NORWAY PINES PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1253
Mailing Address - Country:US
Mailing Address - Phone:218-729-6480
Mailing Address - Fax:218-729-9238
Practice Address - Street 1:4560 NORWAY PINES PL
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1253
Practice Address - Country:US
Practice Address - Phone:218-729-6480
Practice Address - Fax:218-729-9238
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional