Healthcare Provider Details

I. General information

NPI: 1972560472
Provider Name (Legal Business Name): GRANT A. KILLIAN, PH.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 PENINSULA CORPORATE CIR STE 1004
BOCA RATON FL
33487-1378
US

IV. Provider business mailing address

2871 NE 30TH ST
LIGHTHOUSE POINT FL
33064-8524
US

V. Phone/Fax

Practice location:
  • Phone: 954-360-4200
  • Fax: 954-782-9000
Mailing address:
  • Phone: 954-786-9000
  • Fax: 954-782-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY3298
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY3298
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3298
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY3298
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY3298
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY3298
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3298
License Number StateFL

VIII. Authorized Official

Name: GRANT ARAM KILLIAN
Title or Position: PRESIDENT/OWNER
Credential: PH.D.
Phone: 954-786-9000