Individual
MR. CLINT ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
5610 14TH AVE S, GULFPORT, FL 33707-3419
(270) 604-3016
Mailing address
5610 14TH AVE S, GULFPORT, FL 33707-3419
(270) 604-3016
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
MH19899
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
04/20/2011
Last updated
12/21/2021
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