Provider Demographics
NPI:1275279721
Name:GRANT, WENDI MICHELE (MED, LPC-A)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:MICHELE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MED, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15134 SILKY MORNING CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4948
Mailing Address - Country:US
Mailing Address - Phone:713-576-6236
Mailing Address - Fax:
Practice Address - Street 1:15134 SILKY MORNING CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4948
Practice Address - Country:US
Practice Address - Phone:713-576-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional