| Doctor Name: | DR. REVONDA LYNN GRAYSON |
| NPI Number: | 1093893059 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 0810002986 |
| Business Practice Address: | 2200 Bergquist Dr Ste 1 Lackland A F B, TX - 782369908 |
| Business Phone Number: | 2102927722 |
| Business Fax Number: | |
| Mailing Address: | 4127 Luckenbach Rd, SAN ANTONIO |
| State: | TX |
| Postal Code: | 782514305 |
| Phone Number: | 2102927722 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | 0810002986 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |