Provider Demographics
NPI:1588047013
Name:GRABILL, JAMES ROBERT (LISAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:GRABILL
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 E BROADWAY BLVD # C100A
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3901
Mailing Address - Country:US
Mailing Address - Phone:520-514-9888
Mailing Address - Fax:520-514-9878
Practice Address - Street 1:7750 E BROADWAY BLVD # C100A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3901
Practice Address - Country:US
Practice Address - Phone:520-514-9888
Practice Address - Fax:520-514-9878
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1368101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)