Individual
ETHAN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8500 WASHINGTON ST STE A1, ALBUQUERQUE, NM 87113
(505) 828-3837
(877) 828-1550
Mailing address
8500 WASHINGTON ST NE STE A1, ALBUQUERQUE, NM 87113-1861
(505) 828-3837
(877) 828-1550
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/21/2017
Last updated
07/21/2022
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