Provider Demographics
NPI:1427432608
Name:HEBSUR, ROSHA (PSYD)
Entity type:Individual
Prefix:
First Name:ROSHA
Middle Name:
Last Name:HEBSUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N 1ST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 N 1ST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1397
Practice Address - Country:US
Practice Address - Phone:734-668-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016695103TC0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical