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General NPI Number Information
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NPI Number | 1962154138
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Entity Type | Individual
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Provider Name | BYRON SCOTT GROSECLOSE
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Gender | Male
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 4867 BUNKER ST NW
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City | BREMERTON
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State | WA
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Zip | 98311-2470
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Country | US
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Telephone | 925-354-7285
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Fax |
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Provider Business Mailing Address
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Address Line | 300 FAULKNER CT
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City | LINCOLN
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State | CA
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Zip | 95648-2222
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Country | US
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Telephone | 925-354-7285
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF61675260
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License Number State | WA
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