Individual
MR. BLAKE ALAN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
4005 BANISTER LN STE 200C, AUSTIN, TX 78704-8077
(512) 328-7222
Mailing address
4005 BANISTER LN STE 200C, AUSTIN, TX 78704-8077
(806) 893-1778
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1109094
TX
Other
Enumeration date
01/30/2023
Last updated
08/30/2023
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