Provider Demographics
NPI:1922178417
Name:GRANT, JOSEPH BRUCE (MC, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRUCE
Last Name:GRANT
Suffix:
Gender:M
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 E MACAW CT
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85243-3993
Mailing Address - Country:US
Mailing Address - Phone:480-888-2053
Mailing Address - Fax:
Practice Address - Street 1:1232 E BROADWAY RD STE 120
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1510
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:480-967-3528
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional