MEDICARE: ELIZABETH JEAN GRANT BCBA, AMFT, APCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-20-43158	CA
2	106H00000X	Marriage & Family Therapist	154339	CA
3	101YM0800X	Mental Health Counselor	19264	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMFT154339	OTHER	CA	BOARD OF BEHAVIORAL SERVICES
2	APCC19264	OTHER	CA	BOARD OF BEHAVIORAL SERVICES

General Provider Information

NPI Number	:	1487252854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JEAN GRANT BCBA, AMFT, APCC

Provider Business Mailing Address
First Line	:	9343 TECH CENTER DR STE 110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2592
Country	:	US
Telephone Number	:	408-465-8280
Fax Number	:

Provider Business Practice Location Address
First Line	:	9343 TECH CENTER DR STE 110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2592
Country	:	US
Telephone Number	:	408-465-8280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	01/12/2026

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