Provider Demographics
NPI:1508983396
Name:ROSS, BILLY ROGERS JR (LPC)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:ROGERS
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PRITCHETT LN E
Mailing Address - Street 2:
Mailing Address - City:BRUSH CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:38547-2027
Mailing Address - Country:US
Mailing Address - Phone:615-489-5047
Mailing Address - Fax:
Practice Address - Street 1:215 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3439
Practice Address - Country:US
Practice Address - Phone:615-489-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN613101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN42-156-1155OtherEMPLOYEE ID NUMBER