Provider Demographics
NPI:1346338357
Name:PORTEOUS, GRANT ALLAN (LMSW)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:ALLAN
Last Name:PORTEOUS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4725
Mailing Address - Country:US
Mailing Address - Phone:231-715-8466
Mailing Address - Fax:231-943-2263
Practice Address - Street 1:3335 S AIRPORT RD W
Practice Address - Street 2:STE 7B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7928
Practice Address - Country:US
Practice Address - Phone:231-715-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084473101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health