Individual
JARED GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 MULLINS DR, LEBANON, OR 97355-3983
(541) 259-0235
Mailing address
200 MULLINS DR, LEBANON, OR 97355-3983
(541) 259-0235
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/16/2018
Last updated
12/13/2020
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