Provider Demographics
NPI:1851610232
Name:ROSS, JEFFREY DUANE
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DUANE
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WILLIAM D TATE AVE # 800A
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8755
Mailing Address - Country:US
Mailing Address - Phone:817-488-8998
Mailing Address - Fax:855-295-2686
Practice Address - Street 1:3801 WILLIAM D TATE AVE # 800A
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8755
Practice Address - Country:US
Practice Address - Phone:817-488-8998
Practice Address - Fax:855-295-2686
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health