Granholm, Charles R
Granholm, Charles R is an individual health care provider with primary practice located at 200 Brule St Bldg Ireland , Fort Knox KY 40121-6100. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Granholm, Charles R can be contacted via phone (502) 626-9885.Contact Information
Primary practice address
200 Brule St Bldg Ireland
Fort Knox KY 40121-6100
Phone: (502) 626-9885
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 1308 | Kentucky |
Profile Details
| NPI number | 1619953213 |
|---|---|
| LBN Legal business name | Granholm, Charles R |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 16th, 2005 |
| Last updated | Dec 4th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619953213 | NPPES |
| Kentucky | Other | 1308 | STATE LICENSE |
| Kentucky | Other | 34004318A | STATE LICENSE |
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