Provider Demographics
NPI:1013038645
Name:ROSS, JEFFREY M (LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:ROSS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 MANION DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3856
Mailing Address - Country:US
Mailing Address - Phone:409-866-0976
Mailing Address - Fax:409-866-8190
Practice Address - Street 1:9055 MANION DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3856
Practice Address - Country:US
Practice Address - Phone:409-866-0976
Practice Address - Fax:409-866-8190
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health