Provider Demographics
NPI:1285390807
Name:GROSSER, BRANT PAYTON (BEHAVIOR THERAPIST)
Entity type:Individual
Prefix:
First Name:BRANT
Middle Name:PAYTON
Last Name:GROSSER
Suffix:
Gender:M
Credentials:BEHAVIOR THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 MEDICAL PKWY UNIT 311
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7589
Mailing Address - Country:US
Mailing Address - Phone:865-312-4579
Mailing Address - Fax:
Practice Address - Street 1:8517 FM 1826 STE 501
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-1472
Practice Address - Country:US
Practice Address - Phone:512-732-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician