Basic Information
| Provider Information | |||||||||
| NPI: | 1679919609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | BSN:MA:MFT-; CADC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 ALTA DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024746450 | ||||||||
| FaxNumber: | 7024746463 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 ALTA DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024746450 | ||||||||
| FaxNumber: | 7024746463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2013 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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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 | 101YA0400X | 00717 | NV | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | MI0193 | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.