Healthcare Provider Details

I. General information

NPI: 1316582125
Provider Name (Legal Business Name): ANNA KALEN HERNANDEZ GRANGER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA KALEN GRANGER

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 W CARMEL DR STE D4
CARMEL IN
46032-8708
US

IV. Provider business mailing address

1185 W CARMEL DR STE D4
CARMEL IN
46032-8708
US

V. Phone/Fax

Practice location:
  • Phone: 317-569-5433
  • Fax:
Mailing address:
  • Phone: 317-569-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003674A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: