Provider Demographics
NPI:1790816445
Name:CROSBY, CLAY (MFT)
Entity Type:Individual
Prefix:MR
First Name:CLAY
Middle Name:
Last Name:CROSBY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N BEDFORD DR
Mailing Address - Street 2:SUITE 319
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5129
Mailing Address - Country:US
Mailing Address - Phone:310-704-8747
Mailing Address - Fax:
Practice Address - Street 1:360 N BEDFORD DR
Practice Address - Street 2:SUITE 319
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5129
Practice Address - Country:US
Practice Address - Phone:310-704-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40551106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist