Provider Demographics
NPI:1730074022
Name:GRANT, ALEXIS HALEY
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:HALEY
Last Name:GRANT
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 1:9376 RIVER ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9743
Mailing Address - Country:US
Mailing Address - Phone:315-877-7323
Mailing Address - Fax:
Practice Address - Street 1:960 SALT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1696
Practice Address - Country:US
Practice Address - Phone:315-446-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist