Provider Demographics
NPI:1447551056
Name:GROSS, SHIRLEY MARIE
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:MARIE
Other - Last Name:BRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3135
Mailing Address - Country:US
Mailing Address - Phone:636-239-8585
Mailing Address - Fax:636-239-8553
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3135
Practice Address - Country:US
Practice Address - Phone:636-239-8585
Practice Address - Fax:636-239-8553
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MO2010040446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor