Provider Demographics
NPI:1073273298
Name:GRANT, KELSEA ARIEL (LPC)
Entity Type:Individual
Prefix:
First Name:KELSEA
Middle Name:ARIEL
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-2125
Mailing Address - Country:US
Mailing Address - Phone:832-444-2412
Mailing Address - Fax:
Practice Address - Street 1:2000 NORTH LOOP W STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8104
Practice Address - Country:US
Practice Address - Phone:832-413-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional