Provider Demographics
NPI:1720558984
Name:GROSS, STEPHANIE STAR (MS COUNSELING)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:STAR
Last Name:GROSS
Suffix:
Gender:F
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13615 DAISY CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5075
Mailing Address - Country:US
Mailing Address - Phone:909-706-2873
Mailing Address - Fax:
Practice Address - Street 1:491 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3128
Practice Address - Country:US
Practice Address - Phone:626-344-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician