Provider Demographics
NPI:1801494901
Name:ROSS, AMY RENEE (LMSW; MSW U/S)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RENEE
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMSW; MSW U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 NW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-3314
Mailing Address - Country:US
Mailing Address - Phone:580-235-9141
Mailing Address - Fax:
Practice Address - Street 1:501 E 15TH ST STE 400A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5046
Practice Address - Country:US
Practice Address - Phone:405-216-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6509104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker