Healthcare Provider Details

I. General information

NPI: 1699805846
Provider Name (Legal Business Name): JANEL M DOUGLASS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANEL M GROBES MFT

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 GRAVES AVE
ROSEMEAD CA
91770-3414
US

IV. Provider business mailing address

233 WEST BASELINE ROAD BOX 400
LA VERNE CA
91750
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-6510
  • Fax: 626-288-1026
Mailing address:
  • Phone: 909-593-2581
  • Fax: 909-596-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number39150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: