Provider Demographics
NPI:1295806800
Name:GRANT, KRISTIN ROSEMARY (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ROSEMARY
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6138
Mailing Address - Country:US
Mailing Address - Phone:407-327-1765
Mailing Address - Fax:
Practice Address - Street 1:583 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5221
Practice Address - Country:US
Practice Address - Phone:407-327-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH7801OtherMENTAL HEALTH COUNSELOR