Healthcare Provider Details

I. General information

NPI: 1659939213
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL GRASSO LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E GRAND AVE
ESCONDIDO CA
92025-4404
US

IV. Provider business mailing address

737 E GRAND AVE
ESCONDIDO CA
92025-4404
US

V. Phone/Fax

Practice location:
  • Phone: 858-752-4545
  • Fax: 760-745-6852
Mailing address:
  • Phone: 858-752-4545
  • Fax: 760-745-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number74276
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC15716
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberAPCC8010
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC15716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: