Provider Demographics
NPI:1871342790
Name:GROSS, ELLY TAYLOR
Entity type:Individual
Prefix:
First Name:ELLY
Middle Name:TAYLOR
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 SUNSET PL STE C
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6544
Mailing Address - Country:US
Mailing Address - Phone:720-449-6676
Mailing Address - Fax:
Practice Address - Street 1:1823 SUNSET PL
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6552
Practice Address - Country:US
Practice Address - Phone:720-713-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst