Provider Demographics
NPI:1811573207
Name:GRUMPELT, HOWARD RANDALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:RANDALL
Last Name:GRUMPELT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:RANDALL
Other - Last Name:GRUMPELT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:124 ELDERSPIRIT CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3182
Mailing Address - Country:US
Mailing Address - Phone:276-676-0200
Mailing Address - Fax:
Practice Address - Street 1:454 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3408
Practice Address - Country:US
Practice Address - Phone:304-647-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical