Healthcare Provider Details

I. General information

NPI: 1417805797
Provider Name (Legal Business Name): KELLEN R. GRAYSON PSY.D. LMFT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 POLK ST STE 260
SAN FRANCISCO CA
94102-3375
US

IV. Provider business mailing address

4070 BRIDGE ST STE 3
FAIR OAKS CA
95628-7557
US

V. Phone/Fax

Practice location:
  • Phone: 415-320-0141
  • Fax:
Mailing address:
  • Phone: 415-320-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KELLEN R GRAYSON
Title or Position: CEO
Credential: PSY.D. LMFT
Phone: 415-320-0141