Provider Demographics
NPI:1770108839
Name:KNAPP-GROSZ, TAMARA (PHD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:KNAPP-GROSZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 BENEFIT DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5726
Mailing Address - Country:US
Mailing Address - Phone:912-755-5042
Mailing Address - Fax:
Practice Address - Street 1:9312 BENEFIT DR
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-5726
Practice Address - Country:US
Practice Address - Phone:912-755-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002708103T00000X
NC1862103TA0700X
TX38021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging