Provider Demographics
NPI:1780875492
Name:GRANO, STACEY LYNN (LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:GRANO
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:BENDUHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4700 ROCKSIDE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131
Mailing Address - Country:US
Mailing Address - Phone:216-750-2610
Mailing Address - Fax:216-750-2697
Practice Address - Street 1:4700 ROCKSIDE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131
Practice Address - Country:US
Practice Address - Phone:216-750-2610
Practice Address - Fax:216-750-2697
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3839-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health