Provider Demographics
NPI:1396124012
Name:GRANT, JEFFREY ARTHUR (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ARTHUR
Last Name:GRANT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 9TH AVE NE STE 300
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4762
Mailing Address - Country:US
Mailing Address - Phone:206-414-9322
Mailing Address - Fax:
Practice Address - Street 1:4500 9TH AVE NE STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4762
Practice Address - Country:US
Practice Address - Phone:206-414-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60736567103T00000X
WALH60486891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health