Kailey Jia Xin Granstrom, MFT-I

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4335 Issued in NV

Practice address

3455 Cliff Shadows Pkwy Ste 220
Las Vegas, NV 89129-1077

Phone

(702) 673-4745

NPI assigned

Apr 16, 2019

Sex

Female

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

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.

• Autism & Behavioral Consulting Services

  • Behavior Analyst
  • Las Vegas, NV
  • NPI 1881026573
  NPD (past)

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

{
    "created_epoch": "1555372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1295398121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9050 W WARM SPRINGS RD UNIT 1113",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891483830",
            "telephone_number": "203-908-5365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 CLIFF SHADOWS PKWY STE 220",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891291077",
            "telephone_number": "702-673-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANSTROM",
        "first_name": "KAILEY",
        "middle_name": "JIA XIN",
        "credential": "MFT-I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-16",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NV",
            "license": "4335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melizza Granillo
• Granite Sahara Surgical Center, LLC
• Granite Surgery Center
• Diane Grano
• Irvin Shuhei Granstrom, MFT-I, CADC-I
• Grant a Gift Autism Foundation
• Angel D Grant, CASE MANAGER
• Annastaaejai Grant
• Bernadette Dolores Grant, D.C.
• Brejanae Grant

• Marriage & Family Therapist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Marriage & Family Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.