Healthcare Provider Details

I. General information

NPI: 1952472995
Provider Name (Legal Business Name): ALAN L GROSS LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 NORTHCREEK DRIVE #380
CINCINNATI OH
45236-6117
US

IV. Provider business mailing address

401 E MCMILLAN ST
CINCINNATI OH
45206-1922
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-0803
  • Fax: 513-272-4132
Mailing address:
  • Phone: 513-487-7174
  • Fax: 513-475-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI0007705
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberI0007705
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: