Active NPI
Connor Grundy, LAC
- Mental Health Counselor
- Tucson, AZ
National Provider Identifier
1023846136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LAC-22306
- Practice address
- 2295 W Magee Rd Unit 105
Tucson, AZ 85742-4316 - Phone
- (520) 257-1168
- NPI assigned
- Jul 22, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LAC-22306 | AZ | Primary |
Addresses
Primary practice location
2295 W Magee Rd Unit 105
Tucson, AZ 85742-4316
Mailing address
2295 W Magee Rd Unit 105
Tucson, AZ 85742-4316
Phone (520) 257-1168
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3086 W Windsor Crest PL
Tucson, AZ 85742-4853
PO Box
Suite 89784
Tucson, AZ 85752
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-22306 | AZ | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Statt Counseling Services, PLLC | Single Specialty | Current | Accepting new patients |
Locations
2295 W Magee Rd
Unit 105
Tucson, AZ 85742
Phone 5202571168 ext. 713
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721606400000",
"number": "1023846136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2295 W MAGEE RD UNIT 105",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857424316",
"telephone_number": "520-257-1168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2295 W MAGEE RD UNIT 105",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857424316",
"telephone_number": "520-257-1168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUNDY",
"first_name": "CONNOR",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-22",
"last_updated": "2024-07-22",
"certification_date": "2024-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "LAC-22306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.