Provider Demographics
NPI:1992807416
Name:GROOS, CAROLYN FARISH
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:FARISH
Last Name:GROOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:F
Other - Last Name:COLHOUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LCDC
Mailing Address - Street 1:PO BOX 1711
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78636-1711
Mailing Address - Country:US
Mailing Address - Phone:512-680-8787
Mailing Address - Fax:830-868-2099
Practice Address - Street 1:3536 BEE CAVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6654
Practice Address - Country:US
Practice Address - Phone:512-680-8787
Practice Address - Fax:512-327-7398
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S05ZMedicare ID - Type Unspecified