Provider Demographics
NPI:1891087599
Name:ROSS, DESHAWN
Entity Type:Individual
Prefix:
First Name:DESHAWN
Middle Name:
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 1:318 W FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-4837
Mailing Address - Country:US
Mailing Address - Phone:580-791-1054
Mailing Address - Fax:
Practice Address - Street 1:318 W FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-4837
Practice Address - Country:US
Practice Address - Phone:580-791-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor