MEDICARE: MRS. ANGELA D GROSS 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	101YP2500X	Professional Counselor	LPC1587	TN

General Provider Information

NPI Number	:	1518239680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA D GROSS LPC

Provider Business Mailing Address
First Line	:	7345 COURAGE WAY
Second Line	:	STE 101
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1555
Country	:	US
Telephone Number	:	423-454-4866
Fax Number	:	423-602-9796

Provider Business Practice Location Address
First Line	:	7345 COURAGE WAY
Second Line	:	STE 101
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1555
Country	:	US
Telephone Number	:	423-454-4866
Fax Number	:	423-602-9796

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

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	04/12/2016

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