Provider Demographics
NPI:1942303292
Name:GRENNY, GUY WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:WAYNE
Last Name:GRENNY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GUY
Other - Middle Name:WAYNE
Other - Last Name:GRENNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, PHD
Mailing Address - Street 1:347 CYPRESS STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-4024
Mailing Address - Country:US
Mailing Address - Phone:707-961-0733
Mailing Address - Fax:707-961-0675
Practice Address - Street 1:31325 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4024
Practice Address - Country:US
Practice Address - Phone:707-961-0733
Practice Address - Fax:707-961-0675
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT1139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist