Provider Demographics
NPI:1407343122
Name:MS. G & ASSOCIATES
Entity Type:Organization
Organization Name:MS. G & ASSOCIATES
Other - Org Name:SSTARS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BEHAVIORIAL HEALTH THERAPIST, CTO
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-475-7407
Mailing Address - Street 1:325 N MAPLE DR UNIT 2076
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-4769
Mailing Address - Country:US
Mailing Address - Phone:323-475-7407
Mailing Address - Fax:323-475-7407
Practice Address - Street 1:13768 MEADOW VIEW LN
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-7006
Practice Address - Country:US
Practice Address - Phone:323-475-7407
Practice Address - Fax:323-475-7407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MS. G & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty