Healthcare Provider Details

I. General information

NPI: 1821523705
Provider Name (Legal Business Name): RICHARD LYNN GRANSTAFF II LPCC, CATC-IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 UNIVERSITY AVE # 202
SAN DIEGO CA
92103-3312
US

IV. Provider business mailing address

1286 UNIVERSITY AVE # 202
SAN DIEGO CA
92103-3312
US

V. Phone/Fax

Practice location:
  • Phone: 619-995-6876
  • Fax:
Mailing address:
  • Phone: 619-995-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12735
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number122582IV
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: