Healthcare Provider Details

I. General information

NPI: 1710731997
Provider Name (Legal Business Name): ANTHONY P. GULLA AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 N CRESCENT HEIGHTS BLVD APT 106
WEST HOLLYWOOD CA
90046-4542
US

IV. Provider business mailing address

1341 N CRESCENT HEIGHTS BLVD APT 106
WEST HOLLYWOOD CA
90046-4542
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-9376
  • Fax:
Mailing address:
  • Phone: 310-770-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT163167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: