Provider Demographics
NPI:1225688088
Name:GRANLUND, RUBY JUNE (LSCSW/LCSW)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:JUNE
Last Name:GRANLUND
Suffix:
Gender:F
Credentials:LSCSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10668 DERBY MESA CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-4517
Mailing Address - Country:US
Mailing Address - Phone:931-572-8807
Mailing Address - Fax:
Practice Address - Street 1:3230 E WOODMEN RD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8502
Practice Address - Country:US
Practice Address - Phone:719-623-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210334491041C0700X
COMS000000081041C0700X
KS055861041C0700X
MO2019015744104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker