Healthcare Provider Details

I. General information

NPI: 1699206896
Provider Name (Legal Business Name): NANCY GRAIES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E COLORADO ST STE 200
GLENDALE CA
91205-1298
US

IV. Provider business mailing address

6368 HOLLYWOOD BLVD
LOS ANGELES CA
90028-6320
US

V. Phone/Fax

Practice location:
  • Phone: 800-455-7013
  • Fax:
Mailing address:
  • Phone: 323-469-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF98519
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35591
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number94027100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: