Provider Demographics
NPI:1750106977
Name:LAGRAVE, BRITTNEY MICHELLE
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:MICHELLE
Last Name:LAGRAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 VIA BARCELONA
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1604
Mailing Address - Country:US
Mailing Address - Phone:909-451-3803
Mailing Address - Fax:
Practice Address - Street 1:5749 VIA BARCELONA
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1604
Practice Address - Country:US
Practice Address - Phone:909-451-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist