Healthcare Provider Details

I. General information

NPI: 1932599537
Provider Name (Legal Business Name): DENISE GRETCHEN-DOORLY PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9171 WILSHIRE BLVD PENTHOUSE SUITE
BEVERLY HILLS CA
90210-5530
US

IV. Provider business mailing address

9171 WILSHIRE BLVD PENTHOUSE SUITE
BEVERLY HILLS CA
90210-5530
US

V. Phone/Fax

Practice location:
  • Phone: 310-988-9942
  • Fax:
Mailing address:
  • Phone: 310-988-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY25131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: