MEDICARE: LUCINDA GROSS LMFT

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	106H00000X	Marriage & Family Therapist	LMFT-0126	AZ

General Provider Information

NPI Number	:	1639164932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCINDA GROSS LMFT

Provider Business Mailing Address
First Line	:	4915 W BELL RD
Second Line	:	STE 202
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3425
Country	:	US
Telephone Number	:	602-938-3476
Fax Number	:	602-938-6640

Provider Business Practice Location Address
First Line	:	4915 W BELL RD
Second Line	:	STE 202
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3425
Country	:	US
Telephone Number	:	602-938-3476
Fax Number	:	602-938-6640

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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