MEDICARE: MR. ADDAM LEE GROSS MC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC10121	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164419313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADDAM LEE GROSS MC, LPC

Provider Business Mailing Address
First Line	:	6511 N 14TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1467
Country	:	US
Telephone Number	:	602-486-6581
Fax Number	:	602-368-5999

Provider Business Practice Location Address
First Line	:	202 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-4533
Country	:	US
Telephone Number	:	602-486-6581
Fax Number	:	602-368-5999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/09/2007

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