Provider Demographics
NPI:1902435472
Name:ROSS, BRUCE LAMBERT (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LAMBERT
Last Name:ROSS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2359
Mailing Address - Country:US
Mailing Address - Phone:831-212-9170
Mailing Address - Fax:
Practice Address - Street 1:501 MISSION ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3687
Practice Address - Country:US
Practice Address - Phone:831-459-9329
Practice Address - Fax:831-471-5202
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34853106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist