Healthcare Provider Details

I. General information

NPI: 1467855379
Provider Name (Legal Business Name): TRUITT GRANT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PAJARO ST STE D
SALINAS CA
93901-3400
US

IV. Provider business mailing address

PO BOX 541
SEASIDE CA
93955-0541
US

V. Phone/Fax

Practice location:
  • Phone: 831-883-8030
  • Fax:
Mailing address:
  • Phone: 831-747-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: