Healthcare Provider Details

I. General information

NPI: 1184855819
Provider Name (Legal Business Name): RICHARD THOMSON GROSS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CHESTNUT RIDGE RD
MORGANTOWN WV
26505
US

IV. Provider business mailing address

930 CHESTNUT RIDGE RD
MORGANTOWN WV
26505-2807
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4214
  • Fax:
Mailing address:
  • Phone: 304-598-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number447
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: