Basic Information
| Provider Information | |||||||||
| NPI: | 1730601287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15001 E OXFORD AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800144191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036931550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 179 S PARKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809103130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195726162 | ||||||||
| FaxNumber: | 7195726399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2017 | ||||||||
| LastUpdateDate: | 12/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/18/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NLC.0107100 | CO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | LPC.0015873 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.