Provider Demographics
NPI:1992218721
Name:GROSS, LUCILENE A (BCBA)
Entity Type:Individual
Prefix:
First Name:LUCILENE
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 COLLEGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2671
Mailing Address - Country:US
Mailing Address - Phone:913-820-2106
Mailing Address - Fax:913-815-4127
Practice Address - Street 1:8101 COLLEGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2671
Practice Address - Country:US
Practice Address - Phone:913-820-2106
Practice Address - Fax:913-815-4127
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS140103K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator