Provider Demographics
NPI:1881335594
Name:WALKER, GRACEANN FRANCES (LMFT)
Entity type:Individual
Prefix:MISS
First Name:GRACEANN
Middle Name:FRANCES
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:GRACIE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 N PACIFIC COAST HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2147
Mailing Address - Country:US
Mailing Address - Phone:615-767-3079
Mailing Address - Fax:
Practice Address - Street 1:700 N PACIFIC COAST HWY STE 301
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2147
Practice Address - Country:US
Practice Address - Phone:615-767-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA131468OtherPRIVATE THERAPIST