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NPI Code Detail

MEDICARE: MRS. SHANNON GRANT LPCC

MEDICARE: MRS. SHANNON GRANT LPCC
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 Counselor0101111NM

General Provider Information

NPI Number : 1689878605
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON GRANT LPCC
Provider Business Mailing Address
First Line : 7027 MONTGOMERY BLVD NE
Second Line : SUITE F
City : ALBUQUERQUE
State : NM
Zip : 87109-1589
Country : US
Telephone Number : 505-220-0100
Fax Number :
Provider Business Practice Location Address
First Line : 3301 CANDELARIA RD NE STE B
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-1965
Country : US
Telephone Number : 505-880-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 10/24/2017

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Directions to “ MRS. SHANNON GRANT LPCC” Practice Location

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