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Individual

JONATHAN GRANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2120 S BROADWAY, EDMOND, OK 73013-4021
(405) 582-2929
Mailing address
7508 NW 103RD ST, OKLAHOMA CITY, OK 73162-4408

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
09/21/2021
Last updated
09/21/2021
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