Provider Demographics
NPI:1538762364
Name:ARACELI GRANT
Entity type:Organization
Organization Name:ARACELI GRANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARACELI
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LCAC, CSAT
Authorized Official - Phone:317-693-9817
Mailing Address - Street 1:65 EMS C29 LN
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-9098
Mailing Address - Country:US
Mailing Address - Phone:317-693-9817
Mailing Address - Fax:574-267-2251
Practice Address - Street 1:1128 E WINONA AVE STE A2
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4605
Practice Address - Country:US
Practice Address - Phone:317-693-9817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty