Provider Demographics
NPI:1760262422
Name:GRIGSBY, KAYLA RENE (LMFT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENE
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14742 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2013
Mailing Address - Country:US
Mailing Address - Phone:909-520-2577
Mailing Address - Fax:
Practice Address - Street 1:15101 FAIRFIELD RANCH RD UNIT 17306
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-8897
Practice Address - Country:US
Practice Address - Phone:909-520-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist