Provider Demographics
NPI:1346737244
Name:GRANT, SHAMEKA T
Entity Type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:T
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BURBERRY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0033
Mailing Address - Country:US
Mailing Address - Phone:214-493-2313
Mailing Address - Fax:469-520-5283
Practice Address - Street 1:2080 N HWY 360 STE 220
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1451
Practice Address - Country:US
Practice Address - Phone:214-493-2313
Practice Address - Fax:469-520-5283
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional