Provider Demographics
NPI:1396944583
Name:GRANT, DONALD EMMANUEL JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EMMANUEL
Last Name:GRANT
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:834 W KEMP CT
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-4569
Mailing Address - Country:US
Mailing Address - Phone:626-577-2261
Mailing Address - Fax:626-577-2543
Practice Address - Street 1:2555 E COLORADO BLVD
Practice Address - Street 2:SUITE 100-101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6622
Practice Address - Country:US
Practice Address - Phone:626-577-2261
Practice Address - Fax:626-577-2543
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN769OtherLA COUNTY DMH