Provider Demographics
NPI:1447967856
Name:GRISHAM, JEFFREY (PSYD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GRISHAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-0125
Mailing Address - Country:US
Mailing Address - Phone:209-581-1779
Mailing Address - Fax:
Practice Address - Street 1:CA SUBSTANCE ABUSE TREATMENT FACILITY & STATE PRISION
Practice Address - Street 2:900 QUEBEC AVENUE
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-9321
Practice Address - Country:US
Practice Address - Phone:559-992-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program