Provider Demographics
NPI:1831239037
Name:GRELLING, MATTHEW (MA MFT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:GRELLING
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 OCCIDENTAL DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2632
Mailing Address - Country:US
Mailing Address - Phone:951-505-0019
Mailing Address - Fax:
Practice Address - Street 1:1111 GRAND AVE STE J
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4172
Practice Address - Country:US
Practice Address - Phone:951-505-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 35675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health