Provider Demographics
NPI:1598785511
Name:GROSSMAN, GARY ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 COIT RD
Mailing Address - Street 2:1700
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6136
Mailing Address - Country:US
Mailing Address - Phone:972-398-9444
Mailing Address - Fax:972-394-9452
Practice Address - Street 1:1700 COIT RD
Practice Address - Street 2:1700
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6136
Practice Address - Country:US
Practice Address - Phone:972-398-9444
Practice Address - Fax:972-394-9452
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31274103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical