Individual
SHANI LANE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, LPC
Contact information
Practice address
4545 BELLAIRE DR S STE 6, FORT WORTH, TX 76109-1811
(817) 657-1115
Mailing address
4545 BELLAIRE DR S STE 6, FORT WORTH, TX 76109-1811
(817) 657-1115
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
79827
TX
Other
Enumeration date
03/31/2020
Last updated
03/31/2020
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