Healthcare Provider Details

I. General information

NPI: 1306320585
Provider Name (Legal Business Name): GRANT KOENIG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8155 WIND DRIFT CIR
BROWNSBURG IN
46112-8958
US

IV. Provider business mailing address

1555 CHARITY CHASE DR
CARMEL IN
46074-8908
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-2555
  • Fax:
Mailing address:
  • Phone: 317-529-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05805400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: