| Candace W Ross Phd Llc | |
|
900 Peeler St Kalamazoo MI 49008-2300 | |
| (269) 501-8537 | |
| (269) 492-6473 |
| Full Name | Candace W Ross Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 900 Peeler St, Kalamazoo, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (BILLING/CREDENTIALING) |
| Authorized Official Contact | 5176769788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Candace W Ross Phd Llc 900 Peeler St Kalamazoo MI 49008-2300 Ph: (269) 501-8537 | Candace W Ross Phd Llc 900 Peeler St Kalamazoo MI 49008-2300 Ph: (269) 501-8537 |
| NPI Number | 1336682988 |
|---|---|
| Provider Enumeration Date | 11/30/2016 |
| Last Update Date | 11/30/2016 |
| Medicare PECOS PAC ID | 0042593782 |
|---|---|
| Medicare Enrollment ID | O20170203000912 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336682988 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 6301015853 (Michigan) | Primary |
| Provider Name | Candace W Ross |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437417714 PECOS PAC ID: 1759682420 Enrollment ID: I20151222001998 |
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