Individual
DR. DAVID BRYANT GRANTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
296 GAMBLE AVE, MARYVILLE, TN 37801-4943
(865) 980-6464
(865) 977-6823
Mailing address
296 GAMBLE AVE, MARYVILLE, TN 37801-4943
(865) 980-6464
(865) 977-6823
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC0000001693
TN
106H00000X
Marriage & Family Therapist
LMT0000000581
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015174
BLUE CROSS
TN
01
—
431961623
TAX ID
MS
Enumeration date
06/08/2006
Last updated
09/29/2008
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