Healthcare Provider Details

I. General information

NPI: 1639164932
Provider Name (Legal Business Name): LUCINDA GROSS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 W BELL RD STE 202
GLENDALE AZ
85308-3425
US

IV. Provider business mailing address

4915 W BELL RD STE 202
GLENDALE AZ
85308-3425
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3476
  • Fax: 602-938-6640
Mailing address:
  • Phone: 602-938-3476
  • Fax: 602-938-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-0126
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: