Healthcare Provider Details

I. General information

NPI: 1013682780
Provider Name (Legal Business Name): EMALEE GRANT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E WARNER RD STE 115
GILBERT AZ
85296-3133
US

IV. Provider business mailing address

PO BOX 44091
PHOENIX AZ
85064-4091
US

V. Phone/Fax

Practice location:
  • Phone: 480-590-3915
  • Fax:
Mailing address:
  • Phone: 480-620-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-20163
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: