Provider Demographics
NPI:1992860407
Name:GRANT, MARLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-4857
Mailing Address - Country:US
Mailing Address - Phone:530-533-6031
Mailing Address - Fax:
Practice Address - Street 1:1440 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4857
Practice Address - Country:US
Practice Address - Phone:530-533-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional