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General NPI Number Information
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NPI Number | 1194575019
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Entity Type | Organization
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Legal Business Name | GRAY WHALE MARRIAGE AND FAMILY THERAPY PROF CORP
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 8426 FIRESIDE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92123-2848
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Country | US
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Telephone | 714-337-4969
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 231012
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City | SAN DIEGO
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State | CA
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Zip | 92193-1012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAUREN VICTORIA BRUASKI
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Credential | LMFT
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Telephone | 619-213-2470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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