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General NPI Number Information
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NPI Number | 1952604589
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Entity Type | Individual
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Provider Name | NATHANIEL GRANT HOUSE LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 8008 CARONDELET AVE STE 308
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City | CLAYTON
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State | MO
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Zip | 63105-1724
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Country | US
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Telephone | 314-391-8030
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Fax | 833-969-0194
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Provider Business Mailing Address
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Address Line | 2310 RUTGER ST APT C
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City | SAINT LOUIS
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State | MO
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Zip | 63104-2443
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Country | US
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Telephone | 314-599-6584
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149018027
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2017016025
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License Number State | MO
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