Provider Demographics
NPI:1477889780
Name:GRANGER, LORI (LMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GRANGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:LORRAINE
Other - Middle Name:ANNE
Other - Last Name:GRANGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:422 DURANT WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4063
Mailing Address - Country:US
Mailing Address - Phone:415-484-8616
Mailing Address - Fax:
Practice Address - Street 1:422 DURANT WAY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-4063
Practice Address - Country:US
Practice Address - Phone:415-484-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#46228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health