Provider Demographics
NPI:1124474390
Name:GRANT, JENNA ASHLEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:ASHLEY
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1485 W WARM SPRINGS RD STE 109
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7632
Mailing Address - Country:US
Mailing Address - Phone:702-371-5508
Mailing Address - Fax:702-486-6741
Practice Address - Street 1:1485 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7631
Practice Address - Country:US
Practice Address - Phone:702-486-5916
Practice Address - Fax:702-486-7759
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 1041C0700X
NV8723-C1041C0700X
8723-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker