Provider Demographics
NPI:1871103325
Name:GRANT, LUCRESHIA (MS)
Entity type:Individual
Prefix:
First Name:LUCRESHIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 EXCELSIOR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2932
Mailing Address - Country:US
Mailing Address - Phone:612-483-4994
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD STE B
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2932
Practice Address - Country:US
Practice Address - Phone:612-483-4994
Practice Address - Fax:952-920-9323
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist