Provider Demographics
NPI:1154967982
Name:BARLOW, GRANT (LCPC)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:BARLOW
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 N GLENWOOD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1340
Mailing Address - Country:US
Mailing Address - Phone:773-573-6727
Mailing Address - Fax:
Practice Address - Street 1:6331 N GLENWOOD AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1340
Practice Address - Country:US
Practice Address - Phone:773-573-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional