Provider Demographics
NPI:1376283044
Name:BRAND, GABRIEL (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BRAND
Suffix:
Gender:M
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10372 W BRIAR OAKS DR APT C
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-4234
Mailing Address - Country:US
Mailing Address - Phone:310-971-5133
Mailing Address - Fax:
Practice Address - Street 1:10372 W BRIAR OAKS DR APT C
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-4234
Practice Address - Country:US
Practice Address - Phone:310-971-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT125051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist