Provider Demographics
NPI:1558712141
Name:GRANT, CHRISTINA EPIPHANY (RBT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:EPIPHANY
Last Name:GRANT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 N GREEN VALLEY PKWY
Mailing Address - Street 2:BLDG S APT 319
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3661
Mailing Address - Country:US
Mailing Address - Phone:702-542-5953
Mailing Address - Fax:
Practice Address - Street 1:731 MALL RING CIR STE 215
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6691
Practice Address - Country:US
Practice Address - Phone:702-300-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043670300OtherNPI