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General NPI Number Information
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NPI Number | 1922769942
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Entity Type | Individual
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Provider Name | GRACE WILLEN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2022
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Last Update Date | 01/02/2022
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Provider Practice Location Address
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Address Line | 299 N EUCLID AVE STE 300
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City | PASADENA
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State | CA
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Zip | 91101-1544
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Country | US
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Telephone | 707-266-6328
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Fax |
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Provider Business Mailing Address
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Address Line | 4080 GLENCOE AVE UNIT 422
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City | MARINA DEL REY
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State | CA
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Zip | 90292-7508
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Country | US
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Telephone | 310-699-6233
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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 | 124580
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License Number State | CA
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