Provider Demographics
NPI:1649466285
Name:TODD, GRETA (MS)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 SKYPARK DR
Mailing Address - Street 2:STE 210
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5300
Mailing Address - Country:US
Mailing Address - Phone:424-271-2933
Mailing Address - Fax:
Practice Address - Street 1:2790 SKYPARK DR
Practice Address - Street 2:STE 210
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5300
Practice Address - Country:US
Practice Address - Phone:424-271-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA24807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health