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General NPI Number Information
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NPI Number | 1598343493
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Entity Type | Organization
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Legal Business Name | GWEN'S HOUSE MARRIAGE AND FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 7190 W SUNSET BLVD # 62D
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City | LOS ANGELES
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State | CA
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Zip | 90046-4415
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Country | US
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Telephone | 917-409-7719
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Fax |
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Provider Business Mailing Address
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Address Line | 10416 PROSPECTOR LN
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City | MORENO VALLEY
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State | CA
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Zip | 92557-4237
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Country | US
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Telephone | 951-823-4394
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | SHANET DENNIS
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Credential | LMFT
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Telephone | 917-409-7719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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