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General NPI Number Information
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NPI Number | 1841095973
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Entity Type | Organization
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Legal Business Name | VESSELA GRIMM MARRIAGE & FAMILY THERAPY, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 5221 ZELZAH AVE APT 104
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City | ENCINO
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State | CA
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Zip | 91316-2114
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Country | US
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Telephone | 310-985-3406
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Fax |
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Provider Business Mailing Address
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Address Line | 24699 FAIR OAKS LN
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City | MENIFEE
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State | CA
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Zip | 92584-0353
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Country | US
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Telephone | 310-985-3406
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | VESSELA GRIMM
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Credential |
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Telephone | 310-985-3406
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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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