MEDICARE: THE ZIGGURAT GROUP, PA

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	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist
3	103TC2200X	Clinical Child & Adolescent Psychologist	32169	TX
4	103TC2200X	Clinical Child & Adolescent Psychologist	25039	TX
5	103TC2200X	Clinical Child & Adolescent Psychologist	30822	TX
6	225X00000X	Occupational Therapist	109716	TX
7	225X00000X	Occupational Therapist	106089	TX
8	235Z00000X	Speech-Language Pathologist	100328	TX
9	235Z00000X	Speech-Language Pathologist	17458	TX
10	247200000X	Other Technician	0536	TX
11	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295928190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ZIGGURAT GROUP, PA

Provider Business Mailing Address
First Line	:	17430 CAMPBELL RD STE 112
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5297
Country	:	US
Telephone Number	:	214-227-7741
Fax Number	:	214-432-0494

Provider Business Practice Location Address
First Line	:	17430 CAMPBELL RD STE 112
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5297
Country	:	US
Telephone Number	:	214-227-7741
Fax Number	:	214-432-0494

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. BARRY GLENN GROSSMAN
Credential	:	PH.D.
Telephone Number	:	214-227-7741

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	04/14/2023

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