Doctor Name: | MR. LARRY L GRANT |
NPI Number: | 1265566400 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | P0607039 |
Business Practice Address: | 141 Grisham Rd Royal, AR - 719689563 |
Business Phone Number: | 5012822750 |
Business Fax Number: | |
Mailing Address: | 141 Grisham Rd, ROYAL |
State: | AR |
Postal Code: | 719689563 |
Phone Number: | 5012822750 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | P0607039 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |