Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY18336 | CA |
N | 103TC0700X | Clinical Psychologist | PSY18336 | CA |
Y | 103G00000X | Clinical Psychologist | PSY18336 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY18336 | CA |
N | 103TF0000X | Family Psychologist | PSY18336 | CA |
N | 103TH0100X | Health Service | PSY18336 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY18336 | CA |
NPI | 1215256797 |
---|---|
Provider Name | Dr. Craig B. Grether |
First Address | Carlsbad, CA 92011-4022 |
Second Address | Carlsbad, CA 92008-7383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 02/05/2016 |