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General NPI Number Information
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NPI Number | 1023406964
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Entity Type | Organization
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Legal Business Name | GRAY MATTERS
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 617 W 7TH ST 8TH FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90017-3830
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Country | US
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Telephone | 213-293-9408
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Fax |
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Provider Business Mailing Address
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Address Line | 4315 BEETHOVEN ST
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City | LOS ANGELES
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State | CA
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Zip | 90066-6102
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Country | US
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Telephone | 213-300-5440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID IRA SITZER
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Credential | PH.D.
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Telephone | 213-293-9408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY21769
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License Number State | CA
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