Provider Demographics
NPI:1437450939
Name:ROSS JUE, ELLEN LESLIE (MED,LPC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LESLIE
Last Name:ROSS JUE
Suffix:
Gender:F
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 E BLACKLIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2611
Mailing Address - Country:US
Mailing Address - Phone:520-623-4180
Mailing Address - Fax:520-623-4180
Practice Address - Street 1:1037 E BLACKLIDGE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2611
Practice Address - Country:US
Practice Address - Phone:520-623-4180
Practice Address - Fax:520-623-4180
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 0453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health