Organization
PEDIATRIC SPECIALTY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY LAMAR GRANT LPC (MENTAL HEALTH PROFESSIONAL)
(870) 245-2210
Entity
Organization
Contact information
Practice address
2410 PINE ST, ARKADELPHIA, AR 71923-4335
(870) 245-2210
Mailing address
141 GRISHAM RD, ROYAL, AR 71968-9563
(501) 282-2750
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
P0607039
AR
Other
Enumeration date
03/08/2007
Last updated
08/22/2020
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