Provider Demographics
NPI:1083763486
Name:JAMES, GRANT STEVEN (M A LCPC)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:STEVEN
Last Name:JAMES
Suffix:
Gender:M
Credentials:M A LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-4030
Mailing Address - Country:US
Mailing Address - Phone:785-239-7667
Mailing Address - Fax:630-570-5779
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-239-7667
Practice Address - Fax:630-570-5779
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA082101YA0400X
MDLC1219101YP2500X, 101YP2500X
DCPRC1290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780208000OtherMAGELLAN
MD007788700Medicaid
MD204199756OtherFED TAX ID
MDW7220001OtherBCBS CAREFIRST