Provider Demographics
NPI:1386737146
Name:ROSS, STEPHEN DIXON (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DIXON
Last Name:ROSS
Suffix:
Gender:M
Credentials:PSYD
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Other - Credentials:
Mailing Address - Street 1:6900 ALDEN DRIVE
Mailing Address - Street 2:ATTN: 90MDOS/SGOF - FAM HLTH
Mailing Address - City:FE WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82005-3913
Mailing Address - Country:US
Mailing Address - Phone:307-773-3230
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:6900 ALDEN DRIVE
Practice Address - Street 2:ATTN: 90 MDOS/SGOF-FAM HLTH
Practice Address - City:FE WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-3913
Practice Address - Country:US
Practice Address - Phone:307-773-3230
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55807828Medicaid
CO55807828Medicaid