Provider Demographics
NPI:1235868787
Name:GRANA, MADISON ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ELAINE
Last Name:GRANA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 N HOLLAND SYLVANIA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4801
Mailing Address - Country:US
Mailing Address - Phone:419-517-6564
Mailing Address - Fax:
Practice Address - Street 1:4159 N HOLLAND SYLVANIA RD STE 205
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4801
Practice Address - Country:US
Practice Address - Phone:419-517-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OHC.2305263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor