Healthcare Provider Details

I. General information

NPI: 1649447053
Provider Name (Legal Business Name): PAMELA B. GROSSMAN, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 UNIVERSITY DR E SUITE 200
BRYAN TX
77802-3475
US

IV. Provider business mailing address

3201 UNIVERSITY DR E SUITE 200
BRYAN TX
77802-3475
US

V. Phone/Fax

Practice location:
  • Phone: 979-268-7776
  • Fax: 979-268-8618
Mailing address:
  • Phone: 979-268-7776
  • Fax: 979-268-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number25064
License Number StateTX

VIII. Authorized Official

Name: DR. PAMELA B. GROSSMAN
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 979-268-7776