Provider Demographics
NPI:1851486179
Name:GROSSER, DONNA THERESE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:THERESE
Last Name:GROSSER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 3RD ST NW STE 201
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4638
Mailing Address - Country:US
Mailing Address - Phone:863-293-1744
Mailing Address - Fax:863-293-1744
Practice Address - Street 1:65 3RD ST NW STE 201
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4638
Practice Address - Country:US
Practice Address - Phone:863-293-1744
Practice Address - Fax:863-293-1744
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811344100Medicaid