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General NPI Number Information
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NPI Number | 1508983396
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Entity Type | Individual
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Provider Name | BILLY ROGERS ROSS JR. LPC
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Gender | Male
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 215 WILDWOOD AVE
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City | LEBANON
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State | TN
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Zip | 37087-3439
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Country | US
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Telephone | 615-489-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 14 PRITCHETT LN E
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City | BRUSH CREEK
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State | TN
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Zip | 38547-2027
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Country | US
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Telephone | 615-489-5047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 613
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 613
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License Number State | TN
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