Provider Demographics
NPI:1033448352
Name:GROVER, MARK RANDALL (LMSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RANDALL
Last Name:GROVER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:6965 E HACIENDA LA NORIA LN
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-1834
Mailing Address - Country:US
Mailing Address - Phone:602-418-4434
Mailing Address - Fax:
Practice Address - Street 1:6965 E HACIENDA LA NORIA LN
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-1834
Practice Address - Country:US
Practice Address - Phone:602-418-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker