Provider Demographics
NPI:1275847709
Name:ROSS, LYNDA J (PHD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 SPICE ISLANDS DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-219-9015
Mailing Address - Fax:775-853-8545
Practice Address - Street 1:2450 VASSAR ST
Practice Address - Street 2:3A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-219-9015
Practice Address - Fax:775-853-8545
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIP100514106H00000X
NVPY0632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV107908Medicaid