Basic Information
| Provider Information | |||||||||
| NPI: | 1114559556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSI | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE STE 800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 E RUSSELL RD STE A&B | ||||||||
| Address2: | |||||||||
| City: | TECUMSEH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492862072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173665030 | ||||||||
| FaxNumber: | 5173665034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401008836 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.