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NPI Code Detail

MEDICARE: WOLF GRANT

MEDICARE: WOLF GRANT
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
1101YM0800XMental Health CounselorWA

General Provider Information

NPI Number : 1548054307
Entity Type Code : Individual
Provider Name (Legal Business Name) : WOLF GRANT
Provider Business Mailing Address
First Line : 3436 MARY ELDER RD NE
Second Line :
City : OLYMPIA
State : WA
Zip : 98506-5050
Country : US
Telephone Number : 360-373-5031
Fax Number :
Provider Business Practice Location Address
First Line : 3436 MARY ELDER RD NE
Second Line :
City : OLYMPIA
State : WA
Zip : 98506-5050
Country : US
Telephone Number : 360-373-5031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2025
Last Update Date : 04/06/2026

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Directions to “ WOLF GRANT ” Practice Location

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