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General NPI Number Information
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NPI Number | 1346338357
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Entity Type | Individual
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Provider Name | GRANT ALLAN PORTEOUS LMSW
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 3335 S AIRPORT RD W STE 7B
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7928
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Country | US
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Telephone | 231-715-8466
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Fax |
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Provider Business Mailing Address
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Address Line | 3298 VETERANS DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4725
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Country | US
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Telephone | 231-715-8466
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Fax | 231-943-2263
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6801084473
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801084473
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License Number State | MI
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