Provider Demographics
NPI:1760634430
Name:ROSS, EMILY C (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EMMIE
Other - Middle Name:CHRISTINE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-3701
Mailing Address - Country:US
Mailing Address - Phone:409-200-2220
Mailing Address - Fax:409-440-3344
Practice Address - Street 1:4749 ODOM RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7080
Practice Address - Country:US
Practice Address - Phone:409-200-2220
Practice Address - Fax:409-440-3344
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63019101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health