Provider Demographics
NPI:1790483881
Name:KELLY GRANT, JANAY LATESE (LPC)
Entity type:Individual
Prefix:
First Name:JANAY
Middle Name:LATESE
Last Name:KELLY GRANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JANAY
Other - Middle Name:LATESE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:121 WILD RIVER CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-0002
Mailing Address - Country:US
Mailing Address - Phone:214-280-8658
Mailing Address - Fax:
Practice Address - Street 1:121 WILD RIVER CT
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-0002
Practice Address - Country:US
Practice Address - Phone:214-280-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional