Provider Demographics
NPI:1104959188
Name:GRAU, JOYCE T (MFC)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:T
Last Name:GRAU
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 BERGAMO DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3305
Mailing Address - Country:US
Mailing Address - Phone:818-789-2228
Mailing Address - Fax:818-783-6029
Practice Address - Street 1:16944 VENTURA BLVD
Practice Address - Street 2:SUITE # 12
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4144
Practice Address - Country:US
Practice Address - Phone:818-789-6040
Practice Address - Fax:818-789-6029
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist