Provider Demographics
NPI:1477811131
Name:GRANT COONS, RICHARD FREDERICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:GRANT COONS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:FREDERICK
Other - Last Name:COONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2620 J STREET #9
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-572-9442
Mailing Address - Fax:
Practice Address - Street 1:2620 J STREET STE 9
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-572-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical