Provider Demographics
NPI:1003935123
Name:GANT, RACHEL ELIZABETH (MA, MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:GANT
Suffix:
Gender:F
Credentials:MA, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 MURIETTA AVE APT 21
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3466
Mailing Address - Country:US
Mailing Address - Phone:818-267-2729
Mailing Address - Fax:
Practice Address - Street 1:4427 MURIETTA AVE APT 21
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3466
Practice Address - Country:US
Practice Address - Phone:818-267-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50722 INTERN #106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist