Provider Demographics
NPI:1831912146
Name:GRANUM COUNSELING LLC
Entity type:Organization
Organization Name:GRANUM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANUM
Authorized Official - Suffix:
Authorized Official - Credentials:CSW-PIP, QMHP
Authorized Official - Phone:605-774-2204
Mailing Address - Street 1:7808 E MARANA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6455
Mailing Address - Country:US
Mailing Address - Phone:605-774-2204
Mailing Address - Fax:
Practice Address - Street 1:5515 E 18TH STREET, SUITE 130
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110
Practice Address - Country:US
Practice Address - Phone:605-774-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty