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General NPI Number Information
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NPI Number | 1720558984
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Entity Type | Individual
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Provider Name | STEPHANIE STAR GROSS MS COUNSELING
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Gender | Female
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 491 S MARENGO AVE
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City | PASADENA
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State | CA
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Zip | 91101-3128
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Country | US
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Telephone | 626-344-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 13615 DAISY CT
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City | CHINO
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State | CA
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Zip | 91710-5075
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Country | US
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Telephone | 909-706-2873
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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