Provider Demographics
NPI:1952195380
Name:GRANTHAM, AMY (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GRANTHAM
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:COMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4703 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2224
Mailing Address - Country:US
Mailing Address - Phone:806-687-5413
Mailing Address - Fax:806-317-1588
Practice Address - Street 1:4703 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2224
Practice Address - Country:US
Practice Address - Phone:806-687-5413
Practice Address - Fax:806-317-1588
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional