=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942330162
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JERRIANN ELIZABETH GRANT MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 CITRUS CIR STE 235
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-2665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-698-9379
-----------------------------------------------------
Fax | 925-979-9992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 CITRUS CIR STE 235
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-2665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-698-9379
-----------------------------------------------------
Fax | 925-979-9992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 43370
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------