Basic Information
| Provider Information | |||||||||
| NPI: | 1457797979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSSMAN | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15336 DEVONSHIRE ST | ||||||||
| Address2: | UNIT 6 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913452755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185801569 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15336 DEVONSHIRE ST | ||||||||
| Address2: | UNIT 6 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913452755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185801569 | ||||||||
| FaxNumber: | 8184844084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 51041 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.