Healthcare Provider Details

I. General information

NPI: 1457287005
Provider Name (Legal Business Name): KAITLIN GRINER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13287 RALSTON AVE
RANCHO CASCADES CA
91342-1255
US

IV. Provider business mailing address

13287 RALSTON AVE
RANCHO CASCADES CA
91342-1255
US

V. Phone/Fax

Practice location:
  • Phone: 339-793-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: