Timothy Martin Grace, PSYCHOLOGIST
Individual provider Active NPI Clinical Psychologist · Soledad, CA
NPI 1235320391 · NPPES record last updated Jan 18, 2024
Key facts
- NPI
- 1235320391
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY24472 (CA)
- Practice address
- 31625 Highway 101 S
Soledad, CA 93960-9529 - Phone
- (831) 809-6745
- NPI assigned
- Aug 5, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24472 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | PSY24472 | CA | Yes |
Addresses
Primary practice location
31625 Highway 101 S
Soledad, CA 93960-9529
Mailing address
31625 Highway 101 S
Soledad, CA 93960-9529
Phone (831) 809-6745
Other providers in Soledad, CA
- Aliyah Gonzales
- Christopher Gonzales
- Isabela Adriana Gonzalez Crivello
- Diana P Gonzalez
- Maeve Kennedy Gormly
- James Michael Gregg
- Inderjit Singh Grewal
- Jocelyne Guzman Farfan
- Anthony Giabao Ha
- Samantha Hamed
All providers in Soledad, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.