Provider Demographics
NPI:1710916044
Name:GRANTHAM, DANIEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:GRANTHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E STONER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4243
Mailing Address - Country:US
Mailing Address - Phone:318-990-2317
Mailing Address - Fax:318-221-8526
Practice Address - Street 1:1002 HIGHLAND AVE
Practice Address - Street 2:STE 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4143
Practice Address - Country:US
Practice Address - Phone:318-222-6226
Practice Address - Fax:318-221-8526
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional