Mattahshun Simone Van-Grigsby

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-MSXYOI Issued in CA

Practice address

3840 Rosin CT Ste 100
Sacramento, CA 95834-1645

Phone

(916) 921-0828

NPI assigned

Jun 7, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tisha Van-Grigsby Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pacific Clinics

  • Community/Behavioral Health Agency
  • Sacramento, CA
  • NPI 1275070443
  NPD (past)

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

{
    "created_epoch": "1717718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1851133268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8912 VOLUNTEER LN",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958263221",
            "telephone_number": "916-212-8066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 ROSIN CT STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341645",
            "telephone_number": "916-921-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN-GRIGSBY",
        "first_name": "MATTAHSHUN",
        "middle_name": "SIMONE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-07",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-MSXYOI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TISHA",
            "last_name": "VAN-GRIGSBY",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Troy Van Skike
• Kirsten E. Van Voris-Scatena, DPM
• Paul Andrew Van Zeumeren, LMFT
• Krista Kory Van Zeyl, MFT
• Kaylynn Alyssa Van-Bunma
• Glee Van-Loon, R.D.
• Justin Van
• Lam T Van, MD
• Serena Van
• Lynnae Vana

• Peer Specialist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; 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.