Provider Demographics
NPI:1487070694
Name:GRANT, GARRETT
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111338
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-0338
Mailing Address - Country:US
Mailing Address - Phone:281-448-7550
Mailing Address - Fax:281-448-7504
Practice Address - Street 1:2814 ALDINE BENDER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3502
Practice Address - Country:US
Practice Address - Phone:281-448-7550
Practice Address - Fax:281-448-7504
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54658104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical