Individual
MR. LAURENCE RECIO GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6603 WESTLAND DR, BROWNSBURG, IN 46112-7415
(317) 652-9084
Mailing address
6603 WESTLAND DR, BROWNSBURG, IN 46112-7415
(317) 652-9084
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08292015
—
IN
Enumeration date
09/01/2016
Last updated
09/01/2016
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