Provider Demographics
NPI:1841520384
Name:GRANTHAM, HILLARY BETH (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:BETH
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 NW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2234
Mailing Address - Country:US
Mailing Address - Phone:405-209-1276
Mailing Address - Fax:
Practice Address - Street 1:416 SW 79TH ST
Practice Address - Street 2:STE. 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8121
Practice Address - Country:US
Practice Address - Phone:405-246-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional