Provider Demographics
NPI:1427724707
Name:MISTER ROSS COUNSELING LLC
Entity type:Organization
Organization Name:MISTER ROSS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CAADC
Authorized Official - Phone:570-209-5981
Mailing Address - Street 1:1337 SAINT ANN ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-3016
Mailing Address - Country:US
Mailing Address - Phone:570-209-5981
Mailing Address - Fax:
Practice Address - Street 1:1714 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1362
Practice Address - Country:US
Practice Address - Phone:570-209-5981
Practice Address - Fax:570-489-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4587192OtherHIGHMARK
PA1036815540004Medicaid