Doctor Name: | DR. DAVID ROBERT GROH |
NPI Number: | 1356614267 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 2938-057 |
Business Practice Address: | 28208 State Route 1 Suite 101 West Harrison, IN - 470609686 |
Business Phone Number: | 8125761600 |
Business Fax Number: | 8125761602 |
Mailing Address: | 28208 State Route 1, Suite 101 WEST HARRISON |
State: | IN |
Postal Code: | 470609686 |
Phone Number: | 8125761600 |
Fax Number: | 8125761602 |
NPI Enumeration Date: | 02/23/2012 |
NPI Last Update Date: | 03/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2938-057 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |