Provider Demographics
NPI:1336773761
Name:GRAYSON, TAMARA RAE
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:RAE
Last Name:GRAYSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2037
Mailing Address - Country:US
Mailing Address - Phone:925-595-5015
Mailing Address - Fax:
Practice Address - Street 1:3021 CITRUS CIR STE 105
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2643
Practice Address - Country:US
Practice Address - Phone:925-497-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC17999101YM0800X, 101YP2500X
101YP2500X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional