Provider Demographics
NPI:1447391198
Name:GRANT, KENDALL H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENDALL
Middle Name:H
Last Name:GRANT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 ARKANSAS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9099
Mailing Address - Country:US
Mailing Address - Phone:318-396-1711
Mailing Address - Fax:
Practice Address - Street 1:2522 ARKANSAS RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-9099
Practice Address - Country:US
Practice Address - Phone:318-396-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical