Provider Demographics
NPI:1477225472
Name:DR GABRIEL CRENSHAW CLINICAL PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:DR GABRIEL CRENSHAW CLINICAL PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-496-4277
Mailing Address - Street 1:401 WILSHIRE BLVD PH
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1416
Mailing Address - Country:US
Mailing Address - Phone:310-496-4277
Mailing Address - Fax:
Practice Address - Street 1:401 WILSHIRE BLVD PH
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1416
Practice Address - Country:US
Practice Address - Phone:310-496-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)