Provider Demographics
NPI:1588946545
Name:GRANTZ, TAMMY SUE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:GRANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 REDWOOD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6701
Mailing Address - Country:US
Mailing Address - Phone:580-747-3071
Mailing Address - Fax:
Practice Address - Street 1:2925 N. MIDWAY
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701
Practice Address - Country:US
Practice Address - Phone:580-233-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health