Healthcare Provider Details

I. General information

NPI: 1255451837
Provider Name (Legal Business Name): GRANT T MUSE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 E 33RD ST
EDMOND OK
73013-5407
US

IV. Provider business mailing address

PO BOX 623
BETHANY OK
73008-0623
US

V. Phone/Fax

Practice location:
  • Phone: 405-888-5299
  • Fax:
Mailing address:
  • Phone: 405-345-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6744
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: