Provider Demographics
NPI:1164419313
Name:GROSS, ADDAM LEE (MC, LPC)
Entity Type:Individual
Prefix:MR
First Name:ADDAM
Middle Name:LEE
Last Name:GROSS
Suffix:
Gender:M
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 N 14TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1467
Mailing Address - Country:US
Mailing Address - Phone:602-486-6581
Mailing Address - Fax:602-368-5999
Practice Address - Street 1:202 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4533
Practice Address - Country:US
Practice Address - Phone:602-486-6581
Practice Address - Fax:602-368-5999
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ768509Medicaid