Healthcare Provider Details

I. General information

NPI: 1396156758
Provider Name (Legal Business Name): OTIS C GRAIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8118
  • Fax: 661-868-8018
Mailing address:
  • Phone: 661-868-6601
  • Fax: 661-868-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: