KATIE GRANT - NPI NUMBER 1902149115

Summary

Provider Name: KATIE GRANT

NPI Number: 1902149115

Clasification: Counselor (101YP2500X)

Specialization: Professional

Address:
1800 3RD AVE
SUITE 612
ROCK ISLAND, IL
ZIP 61201

Phone Number: (563) 676-6136



Detailed Information

KATIE GRANT is a professional counselor in Rock Island, IL. The assigned NPI number for this provider is 1902149115 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

1800 3RD AVE
SUITE 612
ROCK ISLAND, IL
ZIP 61201-026
Phone: (563) 676-6136
Fax: (815) 377-2599

The provider's authorized official is Katie Grant .
The authorized official title is Owner and has the following contact phone number (563) 676-6136.

The enumeration date for this NPI number is 4/5/2013 and was last updated on 4/5/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 101YP2500X Counselor Professional 180.007951 IL Yes

NPI Record

No. Field Name Field Value
1 NPI 1902149115
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name KATIE GRANT
5 Provider First Line Business Practice Location Address 1800 3RD AVE
6 Provider Second Line Business Practice Location Address SUITE 612
7 Provider Business Practice Location Address City Name ROCK ISLAND
8 Provider Business Practice Location Address State Name IL
9 Provider Business Practice Location Address Postal Code 612018026
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 5636766136
12 Provider Business Practice Location Address Fax Number 8153772599
13 Provider Enumeration Date 4/5/2013
14 Last Update Date 4/5/2013
15 Authorized Official Last Name GRANT
16 Authorized Official First Name KATIE
17 Authorized Official Title or Position OWNER
18 Authorized Official Telephone Number 5636766136
19 Healthcare Provider Taxonomy Code 1 101YP2500X
20 Provider License Number 1 180.007951
21 Provider License Number State Code 1 IL
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Is Organization Subpart N
24 Authorized Official Credential Text MS, LCPC
25 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 8/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.