Provider Demographics
NPI:1356614267
Name:GROH, DAVID ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:GROH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28208 STATE ROUTE 1
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST HARRISON
Mailing Address - State:IN
Mailing Address - Zip Code:47060-9686
Mailing Address - Country:US
Mailing Address - Phone:812-576-1600
Mailing Address - Fax:812-576-1602
Practice Address - Street 1:28208 STATE ROUTE 1
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST HARRISON
Practice Address - State:IN
Practice Address - Zip Code:47060-9686
Practice Address - Country:US
Practice Address - Phone:812-576-1600
Practice Address - Fax:812-576-1602
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042574A103TC0700X
WI2938-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical