Provider Demographics
NPI:1447580626
Name:GRAYSEN, SUSAN TENHOUTEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:TENHOUTEN
Last Name:GRAYSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10573 W PICO BLVD
Mailing Address - Street 2:# 242
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2333
Mailing Address - Country:US
Mailing Address - Phone:310-277-7838
Mailing Address - Fax:310-559-9802
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:SUITE 680
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-277-7838
Practice Address - Fax:310-559-9802
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY11434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical