MEDICARE: ALLAN GRILL CRC, MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 24930	CA

General Provider Information

NPI Number	:	1083639132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLAN GRILL CRC, MFT

Provider Business Mailing Address
First Line	:	3201C ZAFARANO DR # 300
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2668
Country	:	US
Telephone Number	:	510-232-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201C ZAFARANO DR # 300
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2668
Country	:	US
Telephone Number	:	510-232-1630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/09/2024

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