Healthcare Provider Details

I. General information

NPI: 1366306938
Provider Name (Legal Business Name): LYNETTE GRELET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 HWY 116 S
SEBASTOPOL CA
95472-6030
US

IV. Provider business mailing address

2380 PROFESSIONAL DR
SANTA ROSA CA
95403-3016
US

V. Phone/Fax

Practice location:
  • Phone: 707-235-8869
  • Fax:
Mailing address:
  • Phone: 707-360-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: