Provider Demographics
NPI:1699787374
Name:GROSSETT, DEBORAH L (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:GROSSETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1249
Mailing Address - Country:US
Mailing Address - Phone:832-689-1038
Mailing Address - Fax:
Practice Address - Street 1:1101 HEALTH PROFESSIONS BUILDING
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-5645
Practice Address - Country:US
Practice Address - Phone:989-774-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1810103K00000X
MI7401000585103K00000X
TX23342103TC0700X
MI6301015991103TC0700X
TX1-00-0120103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699787374Medicaid
TX81204PMedicare PIN
TX038490102Medicaid
TXR69777Medicare UPIN