Provider Demographics
NPI:1215800990
Name:CONNECTED DEVELOPMENT THERAPEUTIC & TRAINING SERVICES, PLLC
Entity type:Organization
Organization Name:CONNECTED DEVELOPMENT THERAPEUTIC & TRAINING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PHD, LPC, IMH-E
Authorized Official - Phone:616-594-0554
Mailing Address - Street 1:7499 SILVER RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8692
Mailing Address - Country:US
Mailing Address - Phone:616-594-0554
Mailing Address - Fax:
Practice Address - Street 1:7499 SILVER RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8692
Practice Address - Country:US
Practice Address - Phone:616-594-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)