Provider Demographics
NPI:1316718471
Name:GRANT, PATRICK (MSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 WHITNEY WOODS
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9771
Mailing Address - Country:US
Mailing Address - Phone:517-648-3612
Mailing Address - Fax:
Practice Address - Street 1:3125 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2997
Practice Address - Country:US
Practice Address - Phone:269-447-1348
Practice Address - Fax:888-712-9370
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511175581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical