Healthcare Provider Details

I. General information

NPI: 1164608311
Provider Name (Legal Business Name): JUSTIN SCOTT ROSS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 17TH ST SUITE # 2
ASHLAND KY
41101-7628
US

IV. Provider business mailing address

340 17TH ST SUITE # 2
ASHLAND KY
41101-7628
US

V. Phone/Fax

Practice location:
  • Phone: 606-420-4070
  • Fax: 606-420-4071
Mailing address:
  • Phone: 606-420-4070
  • Fax: 606-420-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberKY-0864
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: