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General NPI Number Information
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NPI Number | 1932393907
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Entity Type | Organization
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Legal Business Name | HEIDE GRANT
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 3605 NE LOOP 286 STE 900
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City | PARIS
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State | TX
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Zip | 75460
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Country | US
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Telephone | 903-715-8732
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Fax | 903-782-9082
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Provider Business Mailing Address
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Address Line | 3605 NE LOOP 286 STE 900
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City | PARIS
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State | TX
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Zip | 75460
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Country | US
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Telephone | 903-715-8732
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Fax | 903-782-9082
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MISS HEIDE M GRANT
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Credential | MS LPC
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Telephone | 903-517-6101
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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 | 18698
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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