Provider Demographics
NPI:1760539787
Name:CHIKAZAWA-NELSON, GRANT DAVID (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:DAVID
Last Name:CHIKAZAWA-NELSON
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 18TH AVE S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2784
Mailing Address - Country:US
Mailing Address - Phone:612-455-4040
Mailing Address - Fax:612-455-4041
Practice Address - Street 1:6607 18TH AVE S
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2784
Practice Address - Country:US
Practice Address - Phone:612-455-4040
Practice Address - Fax:612-455-4041
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN540521OtherBEHAVIORAL HEALTH PROVIDE
MN540521OtherVALUE OPTIONS
MN540521OtherBHP
MN69B21CHOtherBCBS BLUEPLUS
MN69B21CHOtherBCBS & BLUE PLUS