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General NPI Number Information
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NPI Number | 1275692188
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Entity Type | Organization
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Legal Business Name | SUSAN GRAYSEN PHD A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 9777 WILSHIRE BLVD STE 1007
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1901
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Country | US
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Telephone | 310-277-7838
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Fax | 310-559-9802
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Provider Business Mailing Address
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Address Line | 10573 W PICO BLVD # 242
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City | LOS ANGELES
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State | CA
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Zip | 90064-2333
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Country | US
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Telephone | 310-277-7838
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Fax | 310-559-9802
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN GRAYSEN
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Credential | PHD
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Telephone | 310-277-7838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY11434
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License Number State | CA
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