Provider Demographics
NPI:1235370412
Name:GROSS, MARTHA L (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 PENNSFIELD PL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5570
Mailing Address - Country:US
Mailing Address - Phone:805-496-6026
Mailing Address - Fax:
Practice Address - Street 1:468 PENNSFIELD PL
Practice Address - Street 2:SUITE 204
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5570
Practice Address - Country:US
Practice Address - Phone:805-496-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist