MEDICARE: VICTORIA GRUTZ MARRIAGE AND FAMILY THERAPY PLLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	153122	OTHER	CA	CALIFORNIA BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1396540258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA GRUTZ MARRIAGE AND FAMILY THERAPY PLLC

Provider Business Mailing Address
First Line	:	1252 XANTHIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3513
Country	:	US
Telephone Number	:	760-567-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1252 XANTHIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3513
Country	:	US
Telephone Number	:	760-567-7006
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VICTORIA GRUTZ
Credential	:	LMFT
Telephone Number	:	760-567-7006

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/14/2025

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