Provider Demographics
NPI:1417740473
Name:SACTOWN THERAPY LLC
Entity type:Organization
Organization Name:SACTOWN THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DR KELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LMFT
Authorized Official - Phone:415-320-0141
Mailing Address - Street 1:4070 BRIDGE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7557
Mailing Address - Country:US
Mailing Address - Phone:415-320-0141
Mailing Address - Fax:916-357-9111
Practice Address - Street 1:4070 BRIDGE ST STE 3
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7557
Practice Address - Country:US
Practice Address - Phone:415-320-0141
Practice Address - Fax:916-357-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty