Provider Demographics
NPI:1154456994
Name:GROVE, BROOKE ASHLEY (MFT INTERN)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:ASHLEY
Last Name:GROVE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10929 SOUTH ST
Mailing Address - Street 2:SUITE 208B
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5340
Mailing Address - Country:US
Mailing Address - Phone:562-924-5526
Mailing Address - Fax:562-924-1040
Practice Address - Street 1:10929 SOUTH ST
Practice Address - Street 2:SUITE 208B
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5340
Practice Address - Country:US
Practice Address - Phone:562-924-5526
Practice Address - Fax:562-924-1040
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT51037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist