Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | MO |
NPI | 1235278474 |
---|---|
Provider Name | Dr. Timothy Richard Grove |
First Address | Saint Louis, MO 63110-1440 |
Second Address | Saint Louis, MO 63110-1440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |