Provider Demographics
NPI:1639054901
Name:GRANT, EMILY E (PPS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:GRANT
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S WASHINGTON ST
Mailing Address - Street 2:WASHINGTON SCHOOL
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425
Mailing Address - Country:US
Mailing Address - Phone:707-894-1940
Mailing Address - Fax:
Practice Address - Street 1:129 S WASHINGTON ST
Practice Address - Street 2:WASHINGTON SCHOOL
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425
Practice Address - Country:US
Practice Address - Phone:707-894-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool