Basic Information
| Provider Information | |||||||||
| NPI: | 1780019372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOREJSI | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AMFT, CATC IV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11027 BURBANK BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916012431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189858323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4445 BURNS AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900292702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232221440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2013 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 133556 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 128959 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.