Individual
DR. JONATHAN BRUCE GRAYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4 E HOLLY ST STE 219, PASADENA, CA 91103-4519
(626) 639-3994
Mailing address
155 CORDOVA ST UNIT 304, PASADENA, CA 91105-2749
(610) 416-0122
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS003671L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049372000
INDEPENDENCE BLUE CROSS
PA
01
—
461698000
MAGELLAN
PA
Enumeration date
08/31/2006
Last updated
10/20/2021
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