Healthcare Provider Details

I. General information

NPI: 1306762364
Provider Name (Legal Business Name): ALYSHA JOI GRIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NEWPORT BLVD STE 350
COSTA MESA CA
92627-2299
US

IV. Provider business mailing address

1901 NEWPORT BLVD STE 350
COSTA MESA CA
92627-2299
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-0527
  • Fax:
Mailing address:
  • Phone: 951-394-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: