Provider Demographics
NPI:1386903664
Name:ROSS, TONYA M (LMSW)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMSW
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 10
Mailing Address - Street 2:312 S OAK
Mailing Address - City:WHITEWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67154-0010
Mailing Address - Country:US
Mailing Address - Phone:316-655-7598
Mailing Address - Fax:
Practice Address - Street 1:312 S OAK
Practice Address - Street 2:BOX 10
Practice Address - City:WHITEWATER
Practice Address - State:KS
Practice Address - Zip Code:67154-0010
Practice Address - Country:US
Practice Address - Phone:316-655-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health