MEDICARE: MR. GEORGE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6134	TX
2	104100000X	Social Worker	02303	TX

General Provider Information

NPI Number	:	1720253099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE GRANT

Provider Business Mailing Address
First Line	:	11814 GLADEWOOD LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2613
Country	:	US
Telephone Number	:	713-729-4752
Fax Number	:	281-442-4900

Provider Business Practice Location Address
First Line	:	2814 ALDINE BENDER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-3502
Country	:	US
Telephone Number	:	281-442-4900
Fax Number	:	281-442-4904

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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Directions to “ MR. GEORGE GRANT ” Practice Location

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