Provider Demographics
NPI:1225244163
Name:GRANT, BETH ANNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BETH ANNE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:GA
Mailing Address - Zip Code:31025-2348
Mailing Address - Country:US
Mailing Address - Phone:478-218-0287
Mailing Address - Fax:
Practice Address - Street 1:300 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6392
Practice Address - Country:US
Practice Address - Phone:478-953-0709
Practice Address - Fax:478-953-0709
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist