Doctor Name: | PAULA SERRA GROSS |
NPI Number: | 1487899555 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 468P |
Business Practice Address: | 1819 Cloud Peak Dr Worland, WY - 824012514 |
Business Phone Number: | 3157300321 |
Business Fax Number: | |
Mailing Address: | 1819 Cloud Peak Dr, WORLAND |
State: | WY |
Postal Code: | 824012514 |
Phone Number: | 3157300321 |
Fax Number: | |
NPI Enumeration Date: | 12/03/2008 |
NPI Last Update Date: | 05/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 468P |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |