Individual
MISTY JOHNETTA ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2942 KNIGHT ST., BLDG. 4 SUITE 426, SHREVEPORT, LA 71105
(318) 754-3560
Mailing address
3555 CEDAR CREEK DR APT 913, SHREVEPORT, LA 71118-2349
(318) 564-7436
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/29/2018
Last updated
12/28/2021
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