Healthcare Provider Details

I. General information

NPI: 1235648668
Provider Name (Legal Business Name): JULIE ROSS, LCSW, LMHP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 E MILITARY AVE STE 200
FREMONT NE
68025-5490
US

IV. Provider business mailing address

1738 PARKVIEW DR
FREMONT NE
68025-4484
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-4886
  • Fax: 402-727-4146
Mailing address:
  • Phone: 402-727-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number918
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number918
License Number StateNE

VIII. Authorized Official

Name: JULIE DIANE ROSS
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW, LMHP
Phone: 402-727-1681