Provider Demographics
NPI:1932498938
Name:LEE-ROSS, KEISHA D
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:D
Last Name:LEE-ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 S 111TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-7826
Mailing Address - Country:US
Mailing Address - Phone:918-277-5781
Mailing Address - Fax:
Practice Address - Street 1:5553 S PEORIA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6800
Practice Address - Country:US
Practice Address - Phone:918-277-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)