Healthcare Provider Details

I. General information

NPI: 1962015628
Provider Name (Legal Business Name): GRAHAMM WIEST PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 320
MISSION VIEJO CA
92691-7320
US

IV. Provider business mailing address

505 N EUCLID ST STE 300
ANAHEIM CA
92801-5514
US

V. Phone/Fax

Practice location:
  • Phone: 949-365-2468
  • Fax:
Mailing address:
  • Phone: 714-871-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number34353
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: