Provider Demographics
NPI:1619192945
Name:GROSS, JOE (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1906
Mailing Address - Country:US
Mailing Address - Phone:918-744-5698
Mailing Address - Fax:918-744-9413
Practice Address - Street 1:3745 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1906
Practice Address - Country:US
Practice Address - Phone:918-744-5698
Practice Address - Fax:918-744-9413
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK06381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical