Individual
SHANNON L GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
323 W WALNUT AVE, BASTROP, LA 71220-4521
(318) 665-9950
Mailing address
2235 NEW NATCHITOCHES RD, WEST MONROE, LA 71292-2125
(318) 393-3464
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
5310
LA
1041C0700X
Clinical Social Worker
Primary
002907292
LA
Other
Enumeration date
03/12/2008
Last updated
09/14/2016
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