MEDICARE: INTRUSTED CARE SOLUTIONS INC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1972944759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRUSTED CARE SOLUTIONS INC

Provider Business Mailing Address
First Line	:	2340 N GRAHAM ST STE B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2506
Country	:	US
Telephone Number	:	980-213-6095
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 N GRAHAM ST STE B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2506
Country	:	US
Telephone Number	:	980-213-6095
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JONATHAN L MCGRANT
Credential	:
Telephone Number	:	704-492-6954

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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Directions to “INTRUSTED CARE SOLUTIONS INC ” Practice Location

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