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1003522293
BLAKE ALAN GRANT
AUSTIN, TX
NPI
1003522293
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: TX 1109094)
Enumeration Date
2023-01-30
Last Update Date
2023-08-30
Business Address
Mr. BLAKE ALAN GRANT PMHNP-BC
4005 BANISTER LN STE 200C
AUSTIN, TX 78704-8077
Phone number: 512-328-7222
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Mailing Address
Mr. BLAKE ALAN GRANT PMHNP-BC
4005 BANISTER LN STE 200C
AUSTIN, TX 78704-8077
Phone number: 806-893-1778
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