Provider Demographics
NPI:1528385630
Name:GRANT, LUCY (MA)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 SIGNAL HILL VW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-8816
Mailing Address - Country:US
Mailing Address - Phone:512-771-3188
Mailing Address - Fax:
Practice Address - Street 1:10250 SIGNAL HILL VW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-8816
Practice Address - Country:US
Practice Address - Phone:512-771-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20240101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor