Active NPI
Charles R Granholm Jr., LCSW
- Clinical Social Worker
- Fort Knox, KY
National Provider Identifier
1619953213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1308
- Practice address
- 200 Brule St BLDG Ireland
Fort Knox, KY 40121-6100 - Phone
- (502) 626-9885
- NPI assigned
- Dec 16, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1308 | KY | Primary |
Addresses
Primary practice location
200 Brule St BLDG Ireland
Fort Knox, KY 40121-6100
Mailing address
200 Brule St BLDG 871
Fort Knox, KY 40121-6100
Phone (502) 626-9877
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1308 | Other | KY | STATE LICENSE |
| 34004318A | Other | IN | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park View Psychiatric Services, PSC | Past | Accepting new patients |
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.
-
- Psychiatric/Mental Health Nurse Practitioner
- Jeffersonville, IN
- NPI 1487872636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701648000000",
"number": "1619953213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 BRULE ST BLDG 871",
"city": "FORT KNOX",
"state": "KY",
"postal_code": "401216100",
"telephone_number": "502-626-9877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BRULE ST BLDG IRELAND",
"city": "FORT KNOX",
"state": "KY",
"postal_code": "401216100",
"telephone_number": "502-626-9885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANHOLM",
"first_name": "CHARLES",
"middle_name": "R",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-16",
"last_updated": "2023-12-04",
"certification_date": "2023-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "1308",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "1308",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "34004318A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Knox, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.