Organization
SHANNON GRANT LLC
Active
Other names
Hands in the Sand Therapeutics
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON RAE GRANT LPCC (THERAPIST/OWNER)
(505) 980-5513
Entity
Organization
Contact information
Practice address
3801 ATRISCO DR NW, SUITE F, ALBUQUERQUE, NM 87120-1688
(505) 980-5513
Mailing address
5831 BURGOS AVE NW, ALBUQUERQUE, NM 87114-5497
(505) 980-5513
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0129011
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689878605
NPI
NM
05
—
22988378
—
NM
Enumeration date
09/30/2016
Last updated
09/30/2016
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