Provider Demographics
NPI:1467695445
Name:GRABB, GWEN (MFT)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:GRABB
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 TEJON PLACE
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1204
Mailing Address - Country:US
Mailing Address - Phone:310-880-3981
Mailing Address - Fax:815-717-7625
Practice Address - Street 1:334 TEJON PL
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1204
Practice Address - Country:US
Practice Address - Phone:310-880-3981
Practice Address - Fax:815-717-7625
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist