Provider Demographics
NPI:1073971057
Name:GROSSMAN & GROSSMAN LTD
Entity Type:Organization
Organization Name:GROSSMAN & GROSSMAN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-410-6635
Mailing Address - Street 1:PO BOX 14948
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4948
Mailing Address - Country:US
Mailing Address - Phone:602-410-6635
Mailing Address - Fax:
Practice Address - Street 1:1707 W SAINT MARYS RD STE 245
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2616
Practice Address - Country:US
Practice Address - Phone:602-468-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ157514Medicaid