Provider Demographics
NPI:1073974234
Name:GRANGER, BRYAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:GRANGER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 AUTO CLUB DR STE 350
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2779
Mailing Address - Country:US
Mailing Address - Phone:313-317-2000
Mailing Address - Fax:313-317-2090
Practice Address - Street 1:5500 AUTO CLUB DR STE 350
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2779
Practice Address - Country:US
Practice Address - Phone:313-317-2000
Practice Address - Fax:313-317-2090
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional