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General NPI Number Information
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NPI Number | 1730074022
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Entity Type | Individual
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Provider Name | ALEXIS HALEY GRANT
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 960 SALT SPRINGS RD
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City | SYRACUSE
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State | NY
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Zip | 13224-1696
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Country | US
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Telephone | 315-446-6250
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Fax |
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Provider Business Mailing Address
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Address Line | 9376 RIVER ISLAND DR
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City | BREWERTON
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State | NY
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Zip | 13029-9743
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Country | US
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Telephone | 315-877-7323
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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