Provider Demographics
NPI:1013486505
Name:GRANDER PEACE COUNSELING LLC
Entity Type:Organization
Organization Name:GRANDER PEACE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LP
Authorized Official - Phone:612-454-1656
Mailing Address - Street 1:658 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3492
Mailing Address - Country:US
Mailing Address - Phone:612-454-1656
Mailing Address - Fax:651-560-3768
Practice Address - Street 1:658 GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3492
Practice Address - Country:US
Practice Address - Phone:612-454-1656
Practice Address - Fax:651-560-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health