Provider Demographics
NPI:1699254698
Name:GROSSMAN, STEFFANIE (PHD, CEDS)
Entity type:Individual
Prefix:
First Name:STEFFANIE
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:PHD, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N DENVER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-2336
Mailing Address - Country:US
Mailing Address - Phone:320-318-0773
Mailing Address - Fax:
Practice Address - Street 1:400 S ZANG BLVD STE 711
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6600
Practice Address - Country:US
Practice Address - Phone:320-318-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37309103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling