Provider Demographics
NPI:1356857999
Name:BOB ROSS, LCSW, LLC
Entity Type:Organization
Organization Name:BOB ROSS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-453-3968
Mailing Address - Street 1:13190 SW TRIGGER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7689
Mailing Address - Country:US
Mailing Address - Phone:503-453-3968
Mailing Address - Fax:
Practice Address - Street 1:12250 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2828
Practice Address - Country:US
Practice Address - Phone:971-249-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty