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General NPI Number Information
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NPI Number | 1801198668
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Entity Type | Organization
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Legal Business Name | ARKLATEX ASSESSMENTS
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 3503 NEW BOSTON RD
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City | TEXARKANA
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State | TX
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Zip | 75501-3139
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Country | US
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Telephone | 903-244-4635
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Fax |
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Provider Business Mailing Address
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Address Line | 3307 PLEASANT GROVE RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0970
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Country | US
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Telephone | 903-244-4635
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. DAVID ROBERT GRANT
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Credential | PH.D.
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Telephone | 903-244-4635
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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 | 33249
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License Number State | TX
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