Individual
JONATHAN W. GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2504 BROWNING ROAD 520, GREENWOOD, MS 38930-6022
(662) 453-6211
Mailing address
PO BOX 1505, GREENWOOD, MS 38935-1505
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1238
MS
Other
Enumeration date
03/12/2013
Last updated
03/12/2013
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