Provider Demographics
NPI:1386956258
Name:GRANT, LEANNE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 871012
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85287-1012
Mailing Address - Country:US
Mailing Address - Phone:480-965-6146
Mailing Address - Fax:
Practice Address - Street 1:9449 N 90TH ST
Practice Address - Street 2:SUITE #210
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5099
Practice Address - Country:US
Practice Address - Phone:480-451-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY#4037103TC0700X
AZ4037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical