MEDICARE: TAMISA LATOYA ROSS LPC-A

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	90460	TX

General Provider Information

NPI Number	:	1679270862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMISA LATOYA ROSS LPC-A

Provider Business Mailing Address
First Line	:	3225 LAKE ARTHUR DR APT 3102
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7621
Country	:	US
Telephone Number	:	409-351-6835
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 LAKE ARTHUR DR APT 3102
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7621
Country	:	US
Telephone Number	:	409-351-6835
Fax Number	:

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

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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