Provider Demographics
NPI:1447065818
Name:GROSS, ERIC SCOTT
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:GROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33400 9TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-2607
Mailing Address - Country:US
Mailing Address - Phone:206-567-7267
Mailing Address - Fax:206-567-7242
Practice Address - Street 1:33400 9TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-2607
Practice Address - Country:US
Practice Address - Phone:206-567-7267
Practice Address - Fax:206-567-7242
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613418C101YS0200X
WAMC61617880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool