Provider Demographics
NPI:1447939384
Name:GRAMS, HARRISON JAMES
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:JAMES
Last Name:GRAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:ANTOINE
Other - Last Name:RIDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NATHAN HARRISON
Mailing Address - Street 1:713 W COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:713 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1612
Practice Address - Country:US
Practice Address - Phone:855-772-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician