Provider Demographics
NPI:1083378467
Name:GRANROOS, SHELBY LYNN (CBT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:GRANROOS
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:GRANROOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CBT
Mailing Address - Street 1:119 HUDSON LN SE APT K203
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-1586
Mailing Address - Country:US
Mailing Address - Phone:678-378-7786
Mailing Address - Fax:
Practice Address - Street 1:8811 S TACOMA WAY STE 206
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4595
Practice Address - Country:US
Practice Address - Phone:253-682-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty