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General NPI Number Information
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NPI Number | 1063250132
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Entity Type | Organization
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Legal Business Name | DERREK ROSS M DIV LAC LCPC PLLC
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Dates
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Enumeration Date | 07/15/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 1601 LEWIS AVE STE 1
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City | BILLINGS
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State | MT
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Zip | 59102-4126
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Country | US
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Telephone | 406-606-9042
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Fax |
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Provider Business Mailing Address
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Address Line | 1842 STONY MEADOW LN
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City | BILLINGS
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State | MT
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Zip | 59101-8990
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Country | US
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Telephone | 406-606-9042
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DERREK ROSS
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Credential | M DIV LAC LCPC
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Telephone | 406-606-9042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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