Provider Demographics
NPI:1811968860
Name:GRADWELL, LOIS ELAINE (MFT)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:ELAINE
Last Name:GRADWELL
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 1:43 QUAIL CT
Mailing Address - Street 2:SUITE 213
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8701
Mailing Address - Country:US
Mailing Address - Phone:925-943-1274
Mailing Address - Fax:925-754-4514
Practice Address - Street 1:43 QUAIL CT
Practice Address - Street 2:SUITE 213
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8701
Practice Address - Country:US
Practice Address - Phone:925-943-1274
Practice Address - Fax:925-754-4514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist