Provider Demographics
NPI:1508754698
Name:GRAN, GITA
Entity type:Individual
Prefix:
First Name:GITA
Middle Name:
Last Name:GRAN
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 1:6302 N 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1201
Mailing Address - Country:US
Mailing Address - Phone:402-496-4326
Mailing Address - Fax:402-496-4326
Practice Address - Street 1:6302 N 142ND AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1201
Practice Address - Country:US
Practice Address - Phone:402-496-4326
Practice Address - Fax:402-496-4326
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional