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General NPI Number Information
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NPI Number | 1356462931
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Entity Type | Individual
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Provider Name | ROSS KENNETH GROSSMAN L.M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 5455 WILSHIRE BLVD 1010
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City | LOS ANGELES
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State | CA
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Zip | 90036-4201
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Country | US
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Telephone | 323-646-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N SYCAMORE AVE APT 21
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City | LOS ANGELES
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State | CA
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Zip | 90036-2947
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Country | US
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Telephone | 323-525-0577
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 31086
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License Number State | CA
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