Basic Information
| Provider Information | |||||||||
| NPI: | 1346452745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | GRAINGER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9837 FOLSOM BLVD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958271356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168565700 | ||||||||
| FaxNumber: | 9168565708 | ||||||||
| Practice Location | |||||||||
| Address1: | 9837 FOLSOM BLVD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958271356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168565700 | ||||||||
| FaxNumber: | 9168565708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2007 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC20706 | CT | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8719 | 01 | CA | MEDI-CAL | OTHER |