Provider Demographics
NPI:1306970553
Name:GROSS, LINDA MARIE (LPC-MH, QMHP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:GROSS
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2646
Mailing Address - Country:US
Mailing Address - Phone:605-559-2006
Mailing Address - Fax:605-559-0243
Practice Address - Street 1:211 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2646
Practice Address - Country:US
Practice Address - Phone:605-559-2006
Practice Address - Fax:605-559-0243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2054101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200090Medicaid
SD4997409OtherBLUE CROSS/BLUE SHIELD