Provider Demographics
NPI:1023390275
Name:GRANT, STEPHANIE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 S GARNETT RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5121
Mailing Address - Country:US
Mailing Address - Phone:405-248-8633
Mailing Address - Fax:
Practice Address - Street 1:2326 S GARNETT RD
Practice Address - Street 2:SUITE G
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5121
Practice Address - Country:US
Practice Address - Phone:405-248-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health