Provider Demographics
NPI:1003318734
Name:GROSSARTH, SEAN HOWARD (PSA, CDCA-P, RA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:HOWARD
Last Name:GROSSARTH
Suffix:
Gender:M
Credentials:PSA, CDCA-P, RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4315
Mailing Address - Country:US
Mailing Address - Phone:740-687-4500
Mailing Address - Fax:740-687-4595
Practice Address - Street 1:201 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4315
Practice Address - Country:US
Practice Address - Phone:740-687-4500
Practice Address - Fax:740-687-4595
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRA.161611405300000X
OHCDCA.166229101YA0400X
OH00435175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No405300000XOther Service ProvidersPrevention Professional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)