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General NPI Number Information
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NPI Number | 1912813502
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Entity Type | Organization
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Legal Business Name | PRISM NEUROHEALTH PC
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Dates
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Enumeration Date | 08/22/2026
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Last Update Date | 08/22/2026
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Provider Practice Location Address
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Address Line | 703 WHISPERING WELL DR
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City | CIBOLO
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State | TX
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Zip | 78108-0440
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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 | 401 E SONTERRA BLVD STE 375
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4321
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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 | PRESIDENT
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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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