Individual
BAILEY ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 JOHNSON ST, ALPENA, MI 49707-1434
(989) 356-2161
Mailing address
400 JOHNSON ST, ALPENA, MI 49707-1434
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
6301017008
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
351866298
—
IN
Enumeration date
02/24/2016
Last updated
03/17/2018
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