MEDICARE: MR. LEONARD LACEY ROSS JR. MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1558520726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEONARD LACEY ROSS JR. MFT

Provider Business Mailing Address
First Line	:	6201 EVENSAIL DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6967
Country	:	US
Telephone Number	:	702-808-9668
Fax Number	:

Provider Business Practice Location Address
First Line	:	7341 W CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1573
Country	:	US
Telephone Number	:	702-808-9668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	09/11/2025

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