Healthcare Provider Details

I. General information

NPI: 1679908081
Provider Name (Legal Business Name): TROY GABRIELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E. 3RD STREET, SUITE C
LOS ANGELES CA
90013
US

IV. Provider business mailing address

470 E. 3RD STREET, SUITE C
LOS ANGELES CA
90013
US

V. Phone/Fax

Practice location:
  • Phone: 213-620-5712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW88106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: