Provider Demographics
NPI:1205906856
Name:GROSS, GREGORY A (MDIV)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:GROSS
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 PIONEERS BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-486-3110
Mailing Address - Fax:
Practice Address - Street 1:3201 PIONEERS BLVD
Practice Address - Street 2:STE 112
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-486-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE867106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5668OtherMIDLANDS ID
NE071164OtherVALUEOPTIONS
NE470807872OtherTAX ID
NE84118OtherBLUECROSS BLUESHIELD
NE47080787226Medicaid
NE349829000OtherMAGELLAN ID