Provider Demographics
NPI:1477633162
Name:GRAHM, JESSICA BRAMBIR (MFCC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BRAMBIR
Last Name:GRAHM
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:BRAMBIR
Other - Last Name:CROMARTY-GRAHM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFCC
Mailing Address - Street 1:3362 CAJON CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 MOBIL AVE
Practice Address - Street 2:STE 211 D
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6325
Practice Address - Country:US
Practice Address - Phone:805-654-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist