Provider Demographics
NPI:1487853628
Name:GRINDELL, VERA M (PHD)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:M
Last Name:GRINDELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VERA
Other - Middle Name:M
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4791 LAGO DR
Mailing Address - Street 2:#107
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-5405
Mailing Address - Country:US
Mailing Address - Phone:714-983-1573
Mailing Address - Fax:
Practice Address - Street 1:4791 LAGO DR
Practice Address - Street 2:#107
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-5405
Practice Address - Country:US
Practice Address - Phone:714-849-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist