Provider Demographics
NPI:1972014819
Name:DANA GRIP, PSYCHOLOGIST, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DANA GRIP, PSYCHOLOGIST, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:RICHARDSON
Authorized Official - Last Name:GRIP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-927-1743
Mailing Address - Street 1:2820 GLENDALE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2723
Mailing Address - Country:US
Mailing Address - Phone:818-927-1743
Mailing Address - Fax:
Practice Address - Street 1:2820 GLENDALE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2723
Practice Address - Country:US
Practice Address - Phone:818-927-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty