Provider Demographics
NPI:1366405474
Name:HALPERN, ROSS FRANKLIN (PHD, LP)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:FRANKLIN
Last Name:HALPERN
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 GREEN COURT
Mailing Address - Street 2:STE 185
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-222-6046
Mailing Address - Fax:734-222-3639
Practice Address - Street 1:3520 GREEN COURT
Practice Address - Street 2:STE 185
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-222-6046
Practice Address - Fax:734-222-3639
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRH008342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI593776870OtherTAX ID
MI680H112660OtherBCBS MI
MI123459OtherPREF CH
MI732008000OtherMAGELLAN/AETNA
MI123459OtherPREF CH
MI680H112660OtherBCBS MI