Provider Demographics
NPI:1114165776
Name:ROSS, MICHAEL D (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:ROSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 W. PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:281-482-3883
Mailing Address - Fax:281-482-9430
Practice Address - Street 1:2051 W PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-8910
Practice Address - Country:US
Practice Address - Phone:281-482-3883
Practice Address - Fax:281-482-9430
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX061731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical