Provider Demographics
NPI:1083212179
Name:GRANDY, JAMIE (LMHC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GRANDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 W OAKWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-7019
Mailing Address - Country:US
Mailing Address - Phone:863-651-2154
Mailing Address - Fax:
Practice Address - Street 1:1735 W OAKWOOD LOOP
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-7019
Practice Address - Country:US
Practice Address - Phone:863-651-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health