MEDICARE: MRS. CAROL ROSS M.ED. L.P.C.

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	101Y00000X	Counselor	20005	TX

General Provider Information

NPI Number	:	1659408151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL ROSS M.ED. L.P.C.

Provider Business Mailing Address
First Line	:	6304 DOUGLAS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1615
Country	:	US
Telephone Number	:	214-361-6064
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 OAK LAWN AVE
Second Line	:	SUITE 812
City	:	DALLAS
State	:	TX
Zip	:	75219-4520
Country	:	US
Telephone Number	:	214-538-1567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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