Provider Demographics
NPI:1043387194
Name:GRANT, HERBERT JR (MA)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:GRANT
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580208
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55458
Mailing Address - Country:US
Mailing Address - Phone:612-247-2338
Mailing Address - Fax:612-728-2039
Practice Address - Street 1:2717 E 42ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-247-2338
Practice Address - Fax:612-728-2039
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist