Provider Demographics
NPI:1700757796
Name:STEPHEN GRANT, LCSW LLC
Entity type:Organization
Organization Name:STEPHEN GRANT, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-752-9943
Mailing Address - Street 1:270 NW 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6622
Mailing Address - Country:US
Mailing Address - Phone:503-752-9943
Mailing Address - Fax:207-209-7656
Practice Address - Street 1:1818 NE IRVING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2238
Practice Address - Country:US
Practice Address - Phone:503-752-9943
Practice Address - Fax:207-209-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)