Provider Demographics
NPI:1942039375
Name:ROSS, TEANNA LANISE (MFA, BFA, CMPSS)
Entity type:Individual
Prefix:MS
First Name:TEANNA
Middle Name:LANISE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MFA, BFA, CMPSS
Other - Prefix:MS
Other - First Name:TEANNA
Other - Middle Name:LANISE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFA, BFA, CMPSS
Mailing Address - Street 1:777 S ALAMEDA ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-1656
Mailing Address - Country:US
Mailing Address - Phone:626-644-1521
Mailing Address - Fax:
Practice Address - Street 1:777 S ALAMEDA ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1656
Practice Address - Country:US
Practice Address - Phone:626-644-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker