Provider Demographics
NPI:1235648668
Name:JULIE ROSS, LCSW, LMHP, LLC
Entity Type:Organization
Organization Name:JULIE ROSS, LCSW, LMHP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMHP
Authorized Official - Phone:402-727-1681
Mailing Address - Street 1:1738 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-4484
Mailing Address - Country:US
Mailing Address - Phone:402-727-1681
Mailing Address - Fax:
Practice Address - Street 1:1627 E MILITARY AVE STE 200
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5490
Practice Address - Country:US
Practice Address - Phone:402-727-4886
Practice Address - Fax:402-727-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE918261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE50778753927Medicaid