Provider Demographics
NPI:1558327163
Name:KEISER, ROSS EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:EDWARD
Last Name:KEISER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 OLD BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6539
Mailing Address - Country:US
Mailing Address - Phone:281-337-3529
Mailing Address - Fax:
Practice Address - Street 1:211 OLD BAYOU DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6539
Practice Address - Country:US
Practice Address - Phone:281-337-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical