1134451347 NPI number — DR. PATRICIA LOUISE GRANT LMHC

Table of content: DR. PATRICIA LOUISE GRANT LMHC (NPI 1134451347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134451347 NPI number — DR. PATRICIA LOUISE GRANT LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
PATRICIA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRANT
Provider Other First Name:
TRISH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134451347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1240 W SIMS WAY
Provider Second Line Business Mailing Address:
141
Provider Business Mailing Address City Name:
PORT TOWNSEND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98368-3058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-379-5470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 OAK BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HADLOCK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98339-8718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-379-5470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH60391478 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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