Provider Demographics
NPI:1265445621
Name:GROVE, WILLIAM JAMES (MFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES
Last Name:GROVE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 2ND ST
Mailing Address - Street 2:#203
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3275
Mailing Address - Country:US
Mailing Address - Phone:760-942-1815
Mailing Address - Fax:858-566-6430
Practice Address - Street 1:230 2ND ST
Practice Address - Street 2:#203
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3275
Practice Address - Country:US
Practice Address - Phone:760-942-1815
Practice Address - Fax:858-566-6430
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMF 021457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist