Provider Demographics
NPI:1548272057
Name:GRANGER, ROSSLYN N (LCSW)
Entity type:Individual
Prefix:
First Name:ROSSLYN
Middle Name:N
Last Name:GRANGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 KATY FWY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1407
Mailing Address - Country:US
Mailing Address - Phone:713-463-9449
Mailing Address - Fax:713-463-7181
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE 312
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-463-9449
Practice Address - Fax:713-463-7181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS117471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S35NOtherBLUE CROSS BLUE SHIELD
TX128945606Medicaid
TX128945603Medicaid
TX8D2972Medicare PIN
TX128945603Medicaid