Provider Demographics
NPI:1356410534
Name:GRANT, STEVEN A (EDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:GRANT
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9726
Mailing Address - Country:US
Mailing Address - Phone:956-244-4441
Mailing Address - Fax:
Practice Address - Street 1:137 SANTA ANA AVE
Practice Address - Street 2:
Practice Address - City:RANCHO VIEJO
Practice Address - State:TX
Practice Address - Zip Code:78575-9726
Practice Address - Country:US
Practice Address - Phone:956-244-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9199101YP2500X
TX3390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0291304-02Medicaid