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General NPI Number Information
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NPI Number | 1194248112
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Entity Type | Individual
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Provider Name | MARK WALTER GRUBER I LMHC, CAP
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Gender | Male
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 100 E SAMPLE RD. #320
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City | POMPANO BEACH
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State | FL
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Zip | 33064
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Country | US
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Telephone | 754-227-2431
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Fax |
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Provider Business Mailing Address
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Address Line | 2996 NE 15TH TER
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City | OAKLAND PARK
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State | FL
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Zip | 33334-4410
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Country | US
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Telephone | 954-993-4670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11710
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License Number State | FL
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