Provider Demographics
NPI:1922728161
Name:GROVE, LINDSEY (PYSCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:GROVE
Suffix:
Gender:F
Credentials:PYSCHOLOGIST
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:FORREST
Other - Last Name:GROVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PYSCHOLOGIST
Mailing Address - Street 1:1650 W ROSEDALE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:682-841-1475
Mailing Address - Fax:
Practice Address - Street 1:1650 W ROSEDALE ST STE 305
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:682-841-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35826101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool