Provider Demographics
NPI:1881166635
Name:SASSE, GRANT MICHAEL (PHD, LPC-MH)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:MICHAEL
Last Name:SASSE
Suffix:
Gender:M
Credentials:PHD, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 KANSAS CITY ST STE 100
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3798
Practice Address - Country:US
Practice Address - Phone:605-348-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELIMHP2609101YP2500X
NELPC2644101YP2500X
NE1435101YA0400X
AKPCOP881101YP2500X
SDLPC-MH30785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)