Provider Demographics
NPI:1427428630
Name:GRANT, JAREE MICHELLE (MSW)
Entity type:Individual
Prefix:
First Name:JAREE
Middle Name:MICHELLE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4005
Mailing Address - Country:US
Mailing Address - Phone:580-326-9475
Mailing Address - Fax:
Practice Address - Street 1:2510 CHICKASAW BLVD.
Practice Address - Street 2:CHICKASAW NATION ARDMORE HEALTH CLINIC
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-226-8181
Practice Address - Fax:580-421-6283
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker