| Doctor Name: | MR. SAMUEL P GROSS |
| NPI Number: | 1114085107 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MALLP, LPC, CSW |
| License Number: | 6801057702 |
| Business Practice Address: | 53950 Van Dyke Ave Suite 210b Shelby Township, MI - 483161819 |
| Business Phone Number: | 5867818400 |
| Business Fax Number: | 5867818300 |
| Mailing Address: | 16991 Dublaine, BEVERLY HILLS |
| State: | MI |
| Postal Code: | 48025 |
| Phone Number: | 2484331069 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2006 |
| NPI Last Update Date: | 04/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6801057702 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |