Provider Demographics
NPI:1942501374
Name:GRAYBILL, SUZANNE MARIE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARIE
Last Name:GRAYBILL
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:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-1059
Mailing Address - Country:US
Mailing Address - Phone:831-229-3161
Mailing Address - Fax:
Practice Address - Street 1:1010 CASS ST
Practice Address - Street 2:SUITE D9
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4515
Practice Address - Country:US
Practice Address - Phone:831-229-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist