Provider Demographics
NPI:1043769482
Name:GRAYBILL, TISHA
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BELLE MILL RD
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2850
Mailing Address - Country:US
Mailing Address - Phone:530-840-2015
Mailing Address - Fax:530-840-2020
Practice Address - Street 1:118 BELLE MILL RD
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2850
Practice Address - Country:US
Practice Address - Phone:530-840-2015
Practice Address - Fax:530-840-2020
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW89580104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker