Provider Demographics
NPI:1922136597
Name:GRAULTY, JOELLEN JEAN
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:JEAN
Last Name:GRAULTY
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 1:405 RED OAK AVENUE #305
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706
Mailing Address - Country:US
Mailing Address - Phone:916-276-5151
Mailing Address - Fax:
Practice Address - Street 1:1320 ARNOLD DR
Practice Address - Street 2:SUITE #160
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6537
Practice Address - Country:US
Practice Address - Phone:925-229-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor