Jeff Clinton Grant, CDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO60944500 Issued in WA

Practice address

235 S 3Rd St
Shelton, WA 98584-2255

Phone

(360) 426-0890

NPI assigned

Aug 19, 2019

Reactivated

Sep 28, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Royal Wa Lacey LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lacey, WA
  • NPI 1336890854
  NPD
• Royal Wa Lacey LLC

  • Substance Abuse Rehabilitation Facility
  • Lacey, WA
  • NPI 1659022861
  NPD
• Northwest Resources II

  • Addiction (Substance Use Disorder) Counselor
  • Shelton, WA
  • NPI 1770647778
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1265089973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1632 CYRENE DR NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985023008",
            "telephone_number": "425-583-8733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 S 3RD ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842255",
            "telephone_number": "360-426-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "JEFF",
        "middle_name": "CLINTON",
        "credential": "CDPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-19",
        "last_updated": "2023-09-28",
        "certification_date": "2023-02-08",
        "deactivation_date": "2023-02-08",
        "reactivation_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60944500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vilma Teresa Gonzalez
• Suzannah Gordon
• Jacqueline Rubylee Gorzynski, MD
• Sarah Elizabeth Goss
• KC Graham, PA-C
• Grapeview School District
• Crystal Louise Green
• Kennedy Green, RN
• Andrew Joel Gulbranson, L.M.P.
• Stephanie Gunter, PHARM D

• Addiction (Substance Use Disorder) Counselor in Shelton, WA
• Providers in Shelton, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.