MEDICARE: GRANT MICHAEL POOLEY

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	LPC-22645	AZ

General Provider Information

NPI Number	:	1841132446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT MICHAEL POOLEY

Provider Business Mailing Address
First Line	:	7075 W BELL RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8546
Country	:	US
Telephone Number	:	602-529-6557
Fax Number	:

Provider Business Practice Location Address
First Line	:	7075 W BELL RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8546
Country	:	US
Telephone Number	:	602-529-6557
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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