MEDICARE: ROSS LENTS, LPC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4729	OK

General Provider Information

NPI Number	:	1568882744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS LENTS, LPC, LLC

Provider Business Mailing Address
First Line	:	2601 NW EXPRESSWAY STE 600W
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7242
Country	:	US
Telephone Number	:	405-471-2211
Fax Number	:	405-753-4995

Provider Business Practice Location Address
First Line	:	2601 NW EXPRESSWAY STE 600W
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7242
Country	:	US
Telephone Number	:	405-471-2211
Fax Number	:	405-753-4995

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ROSS LENTS
Credential	:	LPC
Telephone Number	:	405-471-2211

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	04/25/2014

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