Healthcare Provider Details

I. General information

NPI: 1912836065
Provider Name (Legal Business Name): LINDSEY GRUDT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 LAS VIRGENES RD
CALABASAS CA
91302-1886
US

IV. Provider business mailing address

4111 LAS VIRGENES RD
CALABASAS CA
91302-1886
US

V. Phone/Fax

Practice location:
  • Phone: 818-880-4000
  • Fax:
Mailing address:
  • Phone: 818-880-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: