Provider Demographics
NPI:1558860387
Name:CLEARY, CHRISTOPHER GRAY (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GRAY
Last Name:CLEARY
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:12501 SEAL BEACH BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-8815
Mailing Address - Country:US
Mailing Address - Phone:714-226-9770
Mailing Address - Fax:562-342-2183
Practice Address - Street 1:12501 SEAL BEACH BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-8815
Practice Address - Country:US
Practice Address - Phone:714-226-9770
Practice Address - Fax:562-342-2183
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health