Provider Demographics
NPI:1457797979
Name:GROSSMAN, HOWARD BRIAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:BRIAN
Last Name:GROSSMAN
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 1:15336 DEVONSHIRE ST
Mailing Address - Street 2:UNIT 6
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2755
Mailing Address - Country:US
Mailing Address - Phone:818-580-1569
Mailing Address - Fax:
Practice Address - Street 1:15336 DEVONSHIRE ST
Practice Address - Street 2:UNIT 6
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2755
Practice Address - Country:US
Practice Address - Phone:818-580-1569
Practice Address - Fax:818-484-4084
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist