Healthcare Provider Details

I. General information

NPI: 1891441622
Provider Name (Legal Business Name): TYANA GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27600 CHAGRIN BLVD STE 300
WOODMERE OH
44122-4421
US

IV. Provider business mailing address

3732 NORTHAMPTON RD
CLEVELAND HEIGHTS OH
44121-2027
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-8813
  • Fax:
Mailing address:
  • Phone: 630-803-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC.2203954
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: