Grape Street Community Restoration Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

GRAPE STREET COMMUNITY RESTORATION INC.

Practice address

10139 Beach St Apt 26a-3
Los Angeles, CA 90002-2978

Phone

(323) 801-6071

NPI assigned

Nov 27, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sebastian Dee Randolph, STUDENT COUNSELOR

Title

Clinical Mental Health Counselor

Phone

(602) 736-7383

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1619742244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10139 BEACH ST APT 26A-3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900022978",
            "telephone_number": "323-801-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10139 BEACH ST APT 26A-3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900022978",
            "telephone_number": "323-801-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAPE STREET COMMUNITY RESTORATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-25",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "SEBASTIAN",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "CLINICAL MENTAL HEALTH COUNSELOR",
        "authorized_official_telephone_number": "602-736-7383",
        "authorized_official_credential": "STUDENT COUNSELOR"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Grantham
• Lisa Renee Grantham, PT
• Rebecca L. Grantham, O.T.
• Shannon Grantner, M.S.
• Marwan Granville
• Molly Grassini
• Jessica Grasso
• Katja Kristiina Grasso
• Shira Gratch
• Gail Grate

• Mental Health Counselor in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.