Provider Demographics
NPI:1679841092
Name:GRANT, KARA KELLEY (LPC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:KELLEY
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:KELLEY
Other - Last Name:RIDENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1388
Mailing Address - Country:US
Mailing Address - Phone:281-200-9376
Mailing Address - Fax:281-200-0000
Practice Address - Street 1:303 JACKSON HILL ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7407
Practice Address - Country:US
Practice Address - Phone:281-200-9376
Practice Address - Fax:281-200-0000
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional