Provider Demographics
NPI:1508242884
Name:VORST, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:VORST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 OCEAN FRONT WALK
Mailing Address - Street 2:#212
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3100
Mailing Address - Country:US
Mailing Address - Phone:510-919-0367
Mailing Address - Fax:
Practice Address - Street 1:1725 OCEAN FRONT WALK
Practice Address - Street 2:#212
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3100
Practice Address - Country:US
Practice Address - Phone:510-919-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist