Provider Demographics
NPI:1558520726
Name:ROSS, LEONARD LACEY JR (MFT)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:LACEY
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 EVENSAIL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-6967
Mailing Address - Country:US
Mailing Address - Phone:702-808-9668
Mailing Address - Fax:
Practice Address - Street 1:7341 W CHARLESTON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1573
Practice Address - Country:US
Practice Address - Phone:702-808-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator