Provider Demographics
NPI:1881619815
Name:GRANT, GALE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:GALE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4216
Mailing Address - Country:US
Mailing Address - Phone:281-997-8400
Mailing Address - Fax:281-997-8408
Practice Address - Street 1:2217 PARK AVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4216
Practice Address - Country:US
Practice Address - Phone:281-997-8400
Practice Address - Fax:281-997-8408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0959025-02Medicaid