Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 15497 | CA |
Y | 103T00000X | Psychologist | PSY 15497 | CA |
N | 102L00000X | Psychologist | PSY15497 | CA |
N | 103T00000X | Psychologist | PSY15497 | CA |
N | 103G00000X | Clinical Psychologist | PSY15497 | CA |
N | 103TC0700X | Clinical Psychologist | PSY15497 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY15497 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY 15497 | CA |
NPI | 1053452029 |
---|---|
Provider Name | Dr. Kent Grelling |
First Address | Orinda, CA 94563-2534 |
Second Address | Orinda, CA 94563-2327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2007 |
Last Update Date | 07/07/2014 |