Individual
TERESA GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, SACIT
Contact information
Practice address
1000 N LYNNDALE DR, SUITE C, APPLETON, WI 54914-3056
(920) 735-9010
(920) 735-9050
Mailing address
1000 N LYNNDALE DR, SUITE C, APPLETON, WI 54914-3056
(920) 735-9010
(920) 735-9050
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17985-130
WI
101YM0800X
Mental Health Counselor
Primary
6296-125
WI
Other
Enumeration date
11/15/2016
Last updated
11/23/2016
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