Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY3298 | FL |
Y | 103T00000X | Psychologist | PY3298 | FL |
N | 103TA0700X | Adult Development & Aging Psychologist | PY3298 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY3298 | FL |
N | 103G00000X | Clinical Psychologist | PY3298 | FL |
N | 103TC0700X | Clinical Psychologist | PY3298 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY3298 | FL |
N | 103TF0000X | Family Psychologist | PY3298 | FL |
N | 103TP2701X | Group Psychotherapist | PY3298 | FL |
NPI | 1154443380 |
---|---|
Provider Name | Grant Aram Killian |
First Address | Lighthouse Point, FL 33064-8524 |
Second Address | Boca Raton, FL 33487-1378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R04127 | (02) | FL |