Provider Demographics
NPI:1326677709
Name:GRANGE, SHAUN ROBERT
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:ROBERT
Last Name:GRANGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 RAIN TREE DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-4426
Mailing Address - Country:US
Mailing Address - Phone:405-210-8245
Mailing Address - Fax:
Practice Address - Street 1:429 N UNION AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7019
Practice Address - Country:US
Practice Address - Phone:405-275-1844
Practice Address - Fax:405-275-1124
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional