Provider Demographics
NPI:1033686415
Name:BONNIE GROSS, MA, LPC
Entity Type:Organization
Organization Name:BONNIE GROSS, MA, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:814-827-6648
Mailing Address - Street 1:452 S FRANKLIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-2246
Mailing Address - Country:US
Mailing Address - Phone:814-827-6648
Mailing Address - Fax:814-707-3056
Practice Address - Street 1:452 S FRANKLIN ST STE B
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-2246
Practice Address - Country:US
Practice Address - Phone:814-827-6648
Practice Address - Fax:814-707-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016519830008Medicaid
PA003722233OtherHIGHMARK