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General NPI Number Information
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NPI Number | 1508997792
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Entity Type | Individual
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Provider Name | DOUGLAS E GRANT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 2200 PASEO VERDE PKWY STE 190
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City | HENDERSON
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State | NV
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Zip | 89052-2703
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Country | US
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Telephone | 702-589-4871
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PASEO VERDE PKWY STE 190
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City | HENDERSON
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State | NV
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Zip | 89052-2703
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Country | US
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Telephone | 702-589-4871
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071007205
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY1013
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License Number State | NV
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