Ross, Theresa L.

Ross, Theresa L. is an individual health care provider with primary practice located at 777 Hospital Way Suite G11, Pocatello ID 83201-5175. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Ross, Theresa L. can be contacted via phone (208) 239-1710.

Contact Information

Primary practice address
777 Hospital Way Suite G11 Pocatello ID 83201-5175
Phone: (208) 239-1710
Fax: (208) 239-1713
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY202084 Idaho

Profile Details

NPI number 1891842563
LBN Legal business name Ross, Theresa L.
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2007
Last updated Sep 18th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891842563 NPPES
Idaho MEDICAID 807126900

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