Healthcare Provider Details

I. General information

NPI: 1730686007
Provider Name (Legal Business Name): GRANT JAMES PRENZLER MA, LPC, ATR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 TELEGRAPH RD STE 200
TAYLOR MI
48180-3386
US

IV. Provider business mailing address

23422 TIREMAN ST
DEARBORN HEIGHTS MI
48127-1559
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-4493
  • Fax:
Mailing address:
  • Phone: 989-751-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: