Provider Demographics
NPI:1508697848
Name:GRANNEMAN, BRIAN (LMHC, CAP, CCTP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GRANNEMAN
Suffix:
Gender:M
Credentials:LMHC, CAP, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 29TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-3120
Mailing Address - Country:US
Mailing Address - Phone:239-777-0736
Mailing Address - Fax:
Practice Address - Street 1:501 GOODLETTE RD STE B300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5665
Practice Address - Country:US
Practice Address - Phone:239-212-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health