Provider Demographics
NPI:1447608591
Name:ROSS, LANETTA DOROSE (LPC/LCDC)
Entity Type:Individual
Prefix:
First Name:LANETTA
Middle Name:DOROSE
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPC/LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7525
Mailing Address - Country:US
Mailing Address - Phone:972-965-8802
Mailing Address - Fax:972-230-2118
Practice Address - Street 1:1229 E PLEASANT RUN RD STE 219
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:972-765-1514
Practice Address - Fax:855-301-8724
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5388101YA0400X
TX71895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)