Individual
CHENELLE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4670 LIPSCOMB ST NE STE 10, PALM BAY, FL 32905-2927
(813) 906-6203
Mailing address
4670 LIPSCOMB ST NE STE 10, PALM BAY, FL 32905-2927
(813) 906-6203
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-51835
FL
103K00000X
Behavior Analyst
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104507400
—
FL
Enumeration date
07/19/2018
Last updated
06/28/2023
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