Provider Demographics
NPI:1215252473
Name:GRANPEESHEH, DOREEN (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:GRANPEESHEH
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 GRANITE PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6753
Mailing Address - Country:US
Mailing Address - Phone:817-908-5992
Mailing Address - Fax:866-587-2383
Practice Address - Street 1:12399 LEWIS ST STE 202
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4697
Practice Address - Country:US
Practice Address - Phone:818-345-2345
Practice Address - Fax:866-587-2383
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AZ3956103TC0700X
TX32972103TC0700X
CA12841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst