Provider Demographics
NPI:1396877957
Name:GROSS, THOMAS JAI (MA, NCC, LCPC, LPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAI
Last Name:GROSS
Suffix:
Gender:M
Credentials:MA, NCC, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 N PERKINS RD
Mailing Address - Street 2:E203
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-2205
Mailing Address - Country:US
Mailing Address - Phone:414-915-1449
Mailing Address - Fax:
Practice Address - Street 1:434 WILLARD HALL
Practice Address - Street 2:OKLAHOMA STATE UNIVERSITY
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078
Practice Address - Country:US
Practice Address - Phone:414-915-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3860-125101YP2500X
IL180006515101YP2500X
MO2012022193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional