Provider Demographics
NPI:1164608311
Name:ROSS, JUSTIN SCOTT (LPCC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:SCOTT
Last Name:ROSS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 17TH ST
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7628
Mailing Address - Country:US
Mailing Address - Phone:606-420-4070
Mailing Address - Fax:606-420-4071
Practice Address - Street 1:340 17TH ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7628
Practice Address - Country:US
Practice Address - Phone:606-420-4070
Practice Address - Fax:606-420-4071
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health