Provider Demographics
NPI:1720220072
Name:ROSS, BRUCE O (MS, LPC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:O
Last Name:ROSS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. JOSEPH'S CHILDRE'S HOME
Mailing Address - Street 2:P.O. BOX 1117
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240
Mailing Address - Country:US
Mailing Address - Phone:307-532-4197
Mailing Address - Fax:307-532-8405
Practice Address - Street 1:ST. JOSEPH'S CHILDREN'S HOME
Practice Address - Street 2:1419 MAIN ST
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:307-532-4197
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-087101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional