MEDICARE: NANCY GRAIES

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	101YM0800X	Mental Health Counselor	94027100	CA
2	101YM0800X	Mental Health Counselor	IMF98519	CA
3	103TC0700X	Clinical Psychologist	PSY35591	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7667	OTHER	CA	MEDI-CAL
2	7184	OTHER	CA	MEDI-CAL
3	7368	OTHER	CA	MEDI-CAL
4	7708	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1699206896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY GRAIES

Provider Business Mailing Address
First Line	:	6368 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6320
Country	:	US
Telephone Number	:	323-469-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	6368 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6320
Country	:	US
Telephone Number	:	323-469-5555
Fax Number	:

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

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	05/31/2025

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Directions to “ NANCY GRAIES ” Practice Location

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