Provider Demographics
NPI:1942330162
Name:GRANT, JERRIANN ELIZABETH (MFT)
Entity Type:Individual
Prefix:
First Name:JERRIANN
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CITRUS CIR STE 235
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2665
Mailing Address - Country:US
Mailing Address - Phone:925-698-9379
Mailing Address - Fax:925-979-9992
Practice Address - Street 1:3000 CITRUS CIR STE 235
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2665
Practice Address - Country:US
Practice Address - Phone:925-698-9379
Practice Address - Fax:925-979-9992
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist