Provider Demographics
NPI:1124665799
Name:ROSS, ALISHA DAWN (MS, PLPC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:DAWN
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 E KINGSLEY ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7245
Mailing Address - Country:US
Mailing Address - Phone:417-414-0333
Mailing Address - Fax:
Practice Address - Street 1:1358 E KINGSLEY ST STE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7245
Practice Address - Country:US
Practice Address - Phone:417-414-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019035908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional