Provider Demographics
NPI:1053452029
Name:GRELLING, KENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:GRELLING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21C ORINDA WAY # 141
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2534
Mailing Address - Country:US
Mailing Address - Phone:925-215-8694
Mailing Address - Fax:925-235-7321
Practice Address - Street 1:61 AVENIDA DE ORINDA # 110
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2327
Practice Address - Country:US
Practice Address - Phone:925-215-8694
Practice Address - Fax:925-235-7321
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15497103T00000X, 103TM1800X
CAPSY15497103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities