Provider Demographics
NPI:1124340088
Name:GRAYSON, KATHERINE (MFT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 TELEGRAPH AVE
Mailing Address - Street 2:C-201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1192
Mailing Address - Country:US
Mailing Address - Phone:510-595-5556
Mailing Address - Fax:510-547-0757
Practice Address - Street 1:6536 TELEGRAPH AVE
Practice Address - Street 2:C-201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1192
Practice Address - Country:US
Practice Address - Phone:510-595-5556
Practice Address - Fax:510-547-0757
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47394106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist