Provider Demographics
NPI:1437446507
Name:IMAN J. ROSS, PHD, LPC, P.C.
Entity Type:Organization
Organization Name:IMAN J. ROSS, PHD, LPC, P.C.
Other - Org Name:ROSS PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-236-3999
Mailing Address - Street 1:1106 SANTA FE TRL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3063
Mailing Address - Country:US
Mailing Address - Phone:469-236-3999
Mailing Address - Fax:469-293-4144
Practice Address - Street 1:1106 SANTA FE TRL
Practice Address - Street 2:SUITE 2
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3063
Practice Address - Country:US
Practice Address - Phone:469-236-3999
Practice Address - Fax:469-293-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99184101Y00000X
TX6742101YA0400X
TX18030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty