Provider Demographics
NPI:1679049902
Name:GROVES, TOBAS ANTHONY
Entity type:Individual
Prefix:MR
First Name:TOBAS
Middle Name:ANTHONY
Last Name:GROVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 MADISON CT APT D
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2957
Mailing Address - Country:US
Mailing Address - Phone:317-603-7713
Mailing Address - Fax:
Practice Address - Street 1:1939 MADISON CT APT D
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2957
Practice Address - Country:US
Practice Address - Phone:317-603-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health