Provider Demographics
NPI:1770616476
Name:GRAYSON, HOLLYE CAMRON (MFT)
Entity type:Individual
Prefix:MRS
First Name:HOLLYE
Middle Name:CAMRON
Last Name:GRAYSON
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 1:789 LOCKEARN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1501
Mailing Address - Country:US
Mailing Address - Phone:310-471-0393
Mailing Address - Fax:
Practice Address - Street 1:789 LOCKEARN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1501
Practice Address - Country:US
Practice Address - Phone:310-471-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist