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General NPI Number Information
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NPI Number | 1225972946
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Entity Type | Organization
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Legal Business Name | GRANTED WELLNESS & PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 04/15/2026
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 2453 GRAND CANAL BLVD # 216
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City | STOCKTON
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State | CA
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Zip | 95207-8138
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Country | US
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Telephone | 510-875-3752
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Fax |
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Provider Business Mailing Address
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Address Line | 5517 VINTAGE CIR
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City | STOCKTON
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State | CA
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Zip | 95219-2510
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Country | US
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Telephone | 510-875-3752
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. VENICE J GRANT
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Credential | PSYD
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Telephone | 510-875-3752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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