Healthcare Provider Details

I. General information

NPI: 1689928442
Provider Name (Legal Business Name): GRAZEL GARCIA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 GLENDALE BLVD UNIT B
LOS ANGELES CA
90039-1814
US

IV. Provider business mailing address

3401 GLENDALE BLVD UNIT B
LOS ANGELES CA
90039-1814
US

V. Phone/Fax

Practice location:
  • Phone: 323-487-9003
  • Fax:
Mailing address:
  • Phone: 323-487-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number97561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: