Provider Demographics
NPI:1639836349
Name:MARKS, GABRIEL LAMONTE (AMFT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:LAMONTE
Last Name:MARKS
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 S CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1658
Mailing Address - Country:US
Mailing Address - Phone:310-845-6714
Mailing Address - Fax:
Practice Address - Street 1:1113 S CITRUS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1658
Practice Address - Country:US
Practice Address - Phone:310-494-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT128276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist