Provider Demographics
NPI:1134206519
Name:GRANT-MOORE CENTER FOR BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:GRANT-MOORE CENTER FOR BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-984-2787
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-5906
Mailing Address - Country:US
Mailing Address - Phone:903-984-2787
Mailing Address - Fax:903-984-0517
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-5906
Practice Address - Country:US
Practice Address - Phone:903-984-2787
Practice Address - Fax:903-984-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty