Provider Demographics
NPI:1902335052
Name:GRANTHAM, RACHAEL KELLIE (PSYD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:KELLIE
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 W KURALT DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3629
Mailing Address - Country:US
Mailing Address - Phone:623-341-4150
Mailing Address - Fax:
Practice Address - Street 1:1825 E NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3940
Practice Address - Country:US
Practice Address - Phone:602-997-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2017-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy