Provider Demographics
NPI:1679871248
Name:GRANBERY, ROCHELLE DIANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:DIANE
Last Name:GRANBERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 CUBA CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-2024
Mailing Address - Country:US
Mailing Address - Phone:940-228-9732
Mailing Address - Fax:940-716-9247
Practice Address - Street 1:3209 CUBA CT
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-2024
Practice Address - Country:US
Practice Address - Phone:940-228-9732
Practice Address - Fax:940-716-9247
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health