Provider Demographics
NPI:1821548801
Name:GRANT, STEPHEN P (LMHCA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:GRANT
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 NW 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-5400
Mailing Address - Country:US
Mailing Address - Phone:503-464-6004
Mailing Address - Fax:
Practice Address - Street 1:4824 NW 38TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-5400
Practice Address - Country:US
Practice Address - Phone:503-464-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60689265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health