Provider Demographics
NPI:1114332111
Name:GASTELUM, ROBERT (LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GASTELUM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 SKYPARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5035
Mailing Address - Country:US
Mailing Address - Phone:562-619-5849
Mailing Address - Fax:
Practice Address - Street 1:3333 SKYPARK DR STE 220
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5035
Practice Address - Country:US
Practice Address - Phone:562-619-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 17819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist