Provider Demographics
NPI:1740579895
Name:ROSS, TOBY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:
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 1:16621 COUNTY ROAD 3534
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-0203
Mailing Address - Country:US
Mailing Address - Phone:580-399-5304
Mailing Address - Fax:
Practice Address - Street 1:119 N BROADWAY AVE STE 107
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5049
Practice Address - Country:US
Practice Address - Phone:580-399-5304
Practice Address - Fax:580-399-5304
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health