Provider Demographics
NPI:1992856405
Name:GROSH, KATHLEEN A (PSYS, LLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:GROSH
Suffix:
Gender:F
Credentials:PSYS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1430
Mailing Address - Country:US
Mailing Address - Phone:734-639-2262
Mailing Address - Fax:734-264-4114
Practice Address - Street 1:750 S MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1430
Practice Address - Country:US
Practice Address - Phone:734-639-2262
Practice Address - Fax:734-264-4114
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008929103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical