Provider Demographics
NPI:1588318117
Name:GRANT, JENNIFER (BC-TMH,NCC,LPC,LCDC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:BC-TMH,NCC,LPC,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 DALLAS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8563
Mailing Address - Country:US
Mailing Address - Phone:972-214-6563
Mailing Address - Fax:
Practice Address - Street 1:2591 DALLAS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8563
Practice Address - Country:US
Practice Address - Phone:972-214-6563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15973101YA0400X
TX80318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)