Individual
MR. TIMOTHY LEE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHPP
Contact information
Practice address
3111 S 70TH ST, FORT SMITH, AR 72903-5017
(479) 452-6650
(479) 458-5847
Mailing address
PO BOX 11818, FORT SMITH, AR 72917-1818
(479) 452-6650
(479) 458-5847
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LADAC 0190L
AR
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
08/30/2006
Last updated
08/10/2011
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