Provider Demographics
NPI:1659143600
Name:GODSEY, GRANT J
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:J
Last Name:GODSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 STILL MEADOW DR., N/A
Mailing Address - Street 2:N/A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:407-493-2891
Mailing Address - Fax:
Practice Address - Street 1:12220 STILL MEADOW DR # ANA
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6605
Practice Address - Country:US
Practice Address - Phone:407-493-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical