Jeanette Granstrom, AA, BA, MACP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CG 60151269 Issued in WA

Practice address

4047 Heritage Ave E
Fife, WA 98424-3798

Phone

(253) 259-8645

NPI assigned

Jan 13, 2016

Last updated

Jan 13, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Credentials

Associate of Arts, Bachelor of Arts

State licenses

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452643200000",
    "number": "1891151361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4047 HERITAGE AVE E",
            "city": "FIFE",
            "state": "WA",
            "postal_code": "984243798",
            "telephone_number": "253-259-8645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4047 HERITAGE AVE E",
            "city": "FIFE",
            "state": "WA",
            "postal_code": "984243798",
            "telephone_number": "253-259-8645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANSTROM",
        "first_name": "JEANETTE",
        "credential": "AA, BA, MACP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-13",
        "last_updated": "2016-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CG 60151269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Fife, WA
• Providers in Fife, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2016; 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.