Provider Demographics
NPI:1275388811
Name:GROSS, RACHEL LEAH (LMFT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEAH
Last Name:GROSS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:RAE
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:322 CULVER BLVD UNIT V109
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7704
Mailing Address - Country:US
Mailing Address - Phone:213-222-8923
Mailing Address - Fax:
Practice Address - Street 1:58271 CALIENTE ST
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-8615
Practice Address - Country:US
Practice Address - Phone:213-222-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist