Provider Demographics
NPI:1962511881
Name:NEWBOLD, GRANT N (PSYD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:N
Last Name:NEWBOLD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 32 RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-6612
Mailing Address - Country:US
Mailing Address - Phone:308-830-3070
Mailing Address - Fax:
Practice Address - Street 1:904 E 25TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4603
Practice Address - Country:US
Practice Address - Phone:308-830-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE582103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical