Provider Demographics
NPI:1982770020
Name:ROSS, JAMES MIKE (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MIKE
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:J
Other - Middle Name:MIKE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12741 RESEARCH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4329
Mailing Address - Country:US
Mailing Address - Phone:512-983-1120
Mailing Address - Fax:
Practice Address - Street 1:12741 RESEARCH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4329
Practice Address - Country:US
Practice Address - Phone:512-983-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical