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NPI Code Detail

MEDICARE: MOLLY GRUBER LMFT

MEDICARE: MOLLY GRUBER LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist141152CA

General Provider Information

NPI Number : 1235911702
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY GRUBER LMFT
Provider Business Mailing Address
First Line : 149 S BARRINGTON AVE # 234
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-3310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11845 W OLYMPIC BLVD STE 1050W
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-5046
Country : US
Telephone Number : 888-588-8995
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2023
Last Update Date : 10/18/2023

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Directions to “ MOLLY GRUBER LMFT” Practice Location

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