Provider Demographics
NPI:1952472995
Name:GROSS, ALAN L (LISW)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:L
Last Name:GROSS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1922
Mailing Address - Country:US
Mailing Address - Phone:513-487-7174
Mailing Address - Fax:513-475-5689
Practice Address - Street 1:8260 NORTHCREEK DRIVE
Practice Address - Street 2:#380
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6117
Practice Address - Country:US
Practice Address - Phone:513-271-0803
Practice Address - Fax:513-272-4132
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0007705101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI0007705OtherLISW