Provider Demographics
NPI:1699162537
Name:GROSSMAN, BARRY GLENN (PHD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:GLENN
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 CAMPBELL RD STE 404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1496
Mailing Address - Country:US
Mailing Address - Phone:214-227-7741
Mailing Address - Fax:214-432-0494
Practice Address - Street 1:6220 CAMPBELL RD STE 404
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1496
Practice Address - Country:US
Practice Address - Phone:214-227-7741
Practice Address - Fax:214-432-0494
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist