Provider Demographics
NPI:1245125582
Name:ROSS, JESSI (LPC)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:OK
Mailing Address - Zip Code:73842-0064
Mailing Address - Country:US
Mailing Address - Phone:580-430-8111
Mailing Address - Fax:844-269-9952
Practice Address - Street 1:1424 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3004
Practice Address - Country:US
Practice Address - Phone:580-430-8111
Practice Address - Fax:844-269-9952
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK11954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional