Provider Demographics
NPI:1891543443
Name:GRANT, CHRISTOPHER (MSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 N SMITH RD APT 28
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-3188
Mailing Address - Country:US
Mailing Address - Phone:334-591-0804
Mailing Address - Fax:
Practice Address - Street 1:777 HIGH ST STE 240
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2759
Practice Address - Country:US
Practice Address - Phone:541-357-3248
Practice Address - Fax:541-357-3248
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical