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General NPI Number Information
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NPI Number | 1700247012
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Entity Type | Individual
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Provider Name | BROOKE A GAINES
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Gender | Female
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 679 S NEW HAMPSHIRE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90005-1355
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Country | US
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Telephone | 213-639-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 W 23RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90007-1523
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Country | US
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Telephone | 310-714-4161
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 134992
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License Number State | CA
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