Basic Information
| Provider Information | |||||||||
| NPI: | 1497146831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | MARJORIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 W 29TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820012760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074264728 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1954 W MARIPOSA PKWY | ||||||||
| Address2: | |||||||||
| City: | WHEATLAND | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822013102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073223190 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2015 | ||||||||
| LastUpdateDate: | 11/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-250 | WY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.