Provider Demographics
NPI:1063250132
Name:DERREK ROSS M DIV LAC LCPC PLLC
Entity type:Organization
Organization Name:DERREK ROSS M DIV LAC LCPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:M DIV LAC LCPC
Authorized Official - Phone:406-606-9042
Mailing Address - Street 1:1842 STONY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-8990
Mailing Address - Country:US
Mailing Address - Phone:406-606-9042
Mailing Address - Fax:
Practice Address - Street 1:1601 LEWIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4126
Practice Address - Country:US
Practice Address - Phone:406-606-9042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty