Provider Demographics
NPI:1609222488
Name:GRANT, FREDERICK JR (LPCC)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:GRANT
Suffix:JR
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 SPRINGMILL ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2045
Mailing Address - Country:US
Mailing Address - Phone:419-610-9570
Mailing Address - Fax:
Practice Address - Street 1:875 SPRINGMILL ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2045
Practice Address - Country:US
Practice Address - Phone:419-610-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional