Provider Demographics
NPI:1235577073
Name:GRANT, W. CHRISTOPHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:CHRISTOPHER
Last Name:GRANT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10937 FRUITLAND DR APT 18
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3525
Mailing Address - Country:US
Mailing Address - Phone:818-395-7767
Mailing Address - Fax:
Practice Address - Street 1:28310 ROADSIDE DR STE 138
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4960
Practice Address - Country:US
Practice Address - Phone:818-395-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25646103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist