Healthcare Provider Details

I. General information

NPI: 1194644724
Provider Name (Legal Business Name): GRAFT AND BLOSSOM THERAPY - A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 DONALD DR
HOLLISTER CA
95023-6309
US

IV. Provider business mailing address

421 DONALD DR
HOLLISTER CA
95023-6309
US

V. Phone/Fax

Practice location:
  • Phone: 831-607-8877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA RAMIREZ
Title or Position: PRESIDENT/DIRECTOR
Credential: LCSW
Phone: 831-537-4488