Provider Demographics
NPI:1841470911
Name:GRANT, STEPHEN THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:GRANT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 E BURNSIDE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1767
Mailing Address - Country:US
Mailing Address - Phone:503-752-9943
Mailing Address - Fax:503-230-1012
Practice Address - Street 1:2705 E BURNSIDE ST STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1767
Practice Address - Country:US
Practice Address - Phone:503-752-9943
Practice Address - Fax:503-230-1012
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3820101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health