Provider Demographics
NPI:1659408151
Name:ROSS, CAROL (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:ROSS
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 1:6304 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1615
Mailing Address - Country:US
Mailing Address - Phone:214-361-6064
Mailing Address - Fax:
Practice Address - Street 1:3838 OAK LAWN AVE
Practice Address - Street 2:SUITE 812
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4520
Practice Address - Country:US
Practice Address - Phone:214-538-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20005101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor