Provider Demographics
NPI:1609276781
Name:HART, GRANT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 NE HOGAN DR
Mailing Address - Street 2:STE. E, #140
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-1365
Mailing Address - Country:US
Mailing Address - Phone:503-610-3615
Mailing Address - Fax:971-293-2301
Practice Address - Street 1:7129 NE 154TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5164
Practice Address - Country:US
Practice Address - Phone:503-610-3615
Practice Address - Fax:971-293-2301
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2789103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist