Healthcare Provider Details

I. General information

NPI: 1356482921
Provider Name (Legal Business Name): GRANT WEAVER MA, CDP, MAC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37200 N GANTZEL RD STE 200
SAN TAN VALLEY AZ
85140-7385
US

IV. Provider business mailing address

37200 N GANTZEL RD STE 200
SAN TAN VALLEY AZ
85140-7385
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-5066
  • Fax: 719-623-0165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF-97
License Number StateGU
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4294
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00002621
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00003794
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: