Healthcare Provider Details

I. General information

NPI: 1750898250
Provider Name (Legal Business Name): HUGH MCPHAIL GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 N BEACH RD
EASTSOUND WA
98245-8927
US

IV. Provider business mailing address

PO BOX 632
EASTSOUND WA
98245-0632
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-4002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60631444
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: