Provider Demographics
NPI:1124547161
Name:GRIBIN, RICHARD JAMES (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:GRIBIN
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12402 OTSEGO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3012
Mailing Address - Country:US
Mailing Address - Phone:310-560-4916
Mailing Address - Fax:
Practice Address - Street 1:12402 OTSEGO ST
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3012
Practice Address - Country:US
Practice Address - Phone:310-560-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT38778106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty