Provider Demographics
NPI:1649614736
Name:ACRIE, GARY BRIAN
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:BRIAN
Last Name:ACRIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 16TH ST
Mailing Address - Street 2:ATTN: OPCC-IMHT
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2715
Mailing Address - Country:US
Mailing Address - Phone:909-461-7512
Mailing Address - Fax:
Practice Address - Street 1:1453 16TH ST
Practice Address - Street 2:ATTN: OPCC-IMHT
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2715
Practice Address - Country:US
Practice Address - Phone:909-461-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor