Provider Demographics
NPI:1265671580
Name:GROSS, ERIC M (LPCC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:GROSS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-9547
Mailing Address - Country:US
Mailing Address - Phone:502-345-0980
Mailing Address - Fax:502-479-4420
Practice Address - Street 1:12103 MAPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:KY
Practice Address - Zip Code:40026-9547
Practice Address - Country:US
Practice Address - Phone:502-345-0980
Practice Address - Fax:502-479-4420
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional