Individual
CHANEL Y GRUNDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
914 SOUTH AVE APT C19, SECANE, PA 19018-4463
(484) 206-5044
Mailing address
PO BOX 518, PRIMOS SECANE, PA 19018-0518
(484) 206-5044
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC012465
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
QCH121643587001
INDEPENDENCE HEALTH PLAN EAST
PA
Enumeration date
10/04/2017
Last updated
01/27/2021
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