Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10046 | PA |
N | 101YM0800X | Mental Health Counselor | PC009517 | PA |
Y | 101YP2500X | Professional Counselor | 82232 | TX |
NPI | 1003228388 |
---|---|
Provider Name | David James Grenn |
First Address | Brownsville, TX 78521-4272 |
Second Address | Brownsville, TX 78521-4272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 05/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073614533 | NPI (01) | NY |