Provider Demographics
NPI:1659409969
Name:GRENFELL, SUSAN PATRICIA
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PATRICIA
Last Name:GRENFELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 CARSON RD
Mailing Address - Street 2:
Mailing Address - City:FIELDBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:95519-9738
Mailing Address - Country:US
Mailing Address - Phone:707-839-4972
Mailing Address - Fax:
Practice Address - Street 1:2910 H ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4408
Practice Address - Country:US
Practice Address - Phone:707-441-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist