Provider Demographics
NPI:1376720755
Name:GRANT, ELIZABETH MITCHELL (MHC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MITCHELL
Last Name:GRANT
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-2413
Mailing Address - Country:US
Mailing Address - Phone:301-943-7376
Mailing Address - Fax:301-387-3055
Practice Address - Street 1:901 S PEARL ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-2413
Practice Address - Country:US
Practice Address - Phone:301-943-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0888101YP2500X
WA60621612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD505201700Medicaid