Provider Demographics
NPI:1255543260
Name:BOTH-GRAGG, JANEE BROOKE (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:JANEE
Middle Name:BROOKE
Last Name:BOTH-GRAGG
Suffix:
Gender:F
Credentials:PHD, 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 8160
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-1360
Mailing Address - Country:US
Mailing Address - Phone:909-792-1497
Mailing Address - Fax:909-798-6147
Practice Address - Street 1:101 E REDLANDS BLVD
Practice Address - Street 2:SUITE 234
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4775
Practice Address - Country:US
Practice Address - Phone:800-239-2922
Practice Address - Fax:909-798-6147
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist