Individual
LISA GROSSENBACHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1603 E 19TH ST STE 105, EDMOND, OK 73013-6563
(405) 568-1950
Mailing address
1603 E 19TH ST STE 105, EDMOND, OK 73013-6563
(405) 568-1950
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
4276
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200362310A
—
OK
Enumeration date
02/24/2009
Last updated
08/07/2023
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