Provider Demographics
NPI:1467179218
Name:POWERS, GRANT B
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:B
Last Name:POWERS
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 1:915 LOUNDS ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-3420
Mailing Address - Country:US
Mailing Address - Phone:813-270-0632
Mailing Address - Fax:
Practice Address - Street 1:915 LOUNDS ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-3420
Practice Address - Country:US
Practice Address - Phone:813-270-0632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician