MEDICARE: LAUREN 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700447000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN GRANT

Provider Business Mailing Address
First Line	:	4410 E SAINT LOUIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 E SAINT LOUIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	805-979-9941
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	12/18/2020

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Directions to “ LAUREN GRANT ” Practice Location

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