Provider Demographics
NPI:1457248510
Name:HAEFNER, GRANT MICHAEL
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:MICHAEL
Last Name:HAEFNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31021 VIA COLINAS
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4004
Mailing Address - Country:US
Mailing Address - Phone:949-309-6636
Mailing Address - Fax:
Practice Address - Street 1:7120 HAYVENHURST AVE STE 322
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3813
Practice Address - Country:US
Practice Address - Phone:800-930-5773
Practice Address - Fax:800-930-7957
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician