Healthcare Provider Details

I. General information

NPI: 1821210725
Provider Name (Legal Business Name): GEORGE RAYMOND ROSS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SUMMERTREE COURT
NICHOLASVILLE KY
40356
US

IV. Provider business mailing address

60 SUMMERTREE COURT
NICHOLASVILLE KY
40356
US

V. Phone/Fax

Practice location:
  • Phone: 859-223-5126
  • Fax:
Mailing address:
  • Phone: 859-223-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number466
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number466
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number466
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number466
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number466
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: