Provider Demographics
NPI:1629279575
Name:GRAYBILL, CHERYL LYNN (MFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:CHERI
Other - Middle Name:LYNN
Other - Last Name:DALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:242 W MAIN ST
Mailing Address - Street 2:STE. 104
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7723
Mailing Address - Country:US
Mailing Address - Phone:949-291-0793
Mailing Address - Fax:
Practice Address - Street 1:242 W MAIN ST
Practice Address - Street 2:STE. 104
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7723
Practice Address - Country:US
Practice Address - Phone:714-291-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29981106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist