Provider Demographics
NPI:1396945911
Name:GRANDJEAN, BRIAN RICHARD (LPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
Last Name:GRANDJEAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E BROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-4932
Mailing Address - Country:US
Mailing Address - Phone:903-893-1400
Mailing Address - Fax:
Practice Address - Street 1:302 E BROCKETT ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-4932
Practice Address - Country:US
Practice Address - Phone:903-893-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional