Provider Demographics
NPI:1760838874
Name:BURT B GRENELL PHD PLLC
Entity Type:Organization
Organization Name:BURT B GRENELL PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRENELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-337-2999
Mailing Address - Street 1:1226 31ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3402
Mailing Address - Country:US
Mailing Address - Phone:202-337-2999
Mailing Address - Fax:
Practice Address - Street 1:1226 31ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3402
Practice Address - Country:US
Practice Address - Phone:202-337-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1552261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)