Provider Demographics
NPI:1134571813
Name:GROVE, CATRINA ELAINE
Entity type:Individual
Prefix:
First Name:CATRINA
Middle Name:ELAINE
Last Name:GROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATRINA
Other - Middle Name:ELAINE
Other - Last Name:GROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 W 6TH ST
Mailing Address - Street 2:230
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3316
Mailing Address - Country:US
Mailing Address - Phone:310-833-3135
Mailing Address - Fax:310-707-2877
Practice Address - Street 1:222 W 6TH ST
Practice Address - Street 2:230
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3316
Practice Address - Country:US
Practice Address - Phone:310-833-3135
Practice Address - Fax:310-707-2877
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT113270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist