Provider Demographics
NPI:1134102890
Name:GROSS, CAROLE L (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23441 S POINTE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1549
Mailing Address - Country:US
Mailing Address - Phone:949-597-1103
Mailing Address - Fax:949-597-1103
Practice Address - Street 1:23441 S POINTE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1549
Practice Address - Country:US
Practice Address - Phone:949-597-1103
Practice Address - Fax:949-597-1103
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist