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General NPI Number Information
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NPI Number | 1447726781
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Entity Type | Individual
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Provider Name | JONATHAN MICHAEL GRABYAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2018
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Last Update Date | 10/14/2018
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Provider Practice Location Address
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Address Line | 2002 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4211
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Country | US
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Telephone | 713-791-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 MEMORIAL DR APT 310
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City | HOUSTON
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State | TX
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Zip | 77007-8252
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Country | US
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Telephone | 949-981-3872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2647
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License Number State | KS
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