| Doctor Name: | DR. KENT GRELLING |
| NPI Number: | 1053452029 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PSY15497 |
| Business Practice Address: | 61 Avenida De Orinda # 110 Orinda, CA - 945632327 |
| Business Phone Number: | 9252158694 |
| Business Fax Number: | 9252357321 |
| Mailing Address: | 21c Orinda Way # 141, ORINDA |
| State: | CA |
| Postal Code: | 945632534 |
| Phone Number: | 9252158694 |
| Fax Number: | 9252357321 |
| NPI Enumeration Date: | 02/10/2007 |
| NPI Last Update Date: | 07/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY15497 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |