Provider Demographics
NPI:1407065519
Name:GROSS, PAMELA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:H
Last Name:GROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 DUTCH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-5116
Mailing Address - Country:US
Mailing Address - Phone:865-435-4414
Mailing Address - Fax:
Practice Address - Street 1:1729 DUTCH VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-5116
Practice Address - Country:US
Practice Address - Phone:865-435-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2167103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist