| Dr Gabriel Crenshaw Clinical Psychologist Inc | |
|
401 Wilshire Blvd Ph Santa Monica CA 90401-1416 | |
| (310) 496-4277 | |
| Not Available |
| Full Name | Dr Gabriel Crenshaw Clinical Psychologist Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 401 Wilshire Blvd Ph, Santa Monica, California |
| Authorized Official Name and Position | Gabriel Crenshaw (OWNER) |
| Authorized Official Contact | 3104964277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Gabriel Crenshaw Clinical Psychologist Inc 401 Wilshire Blvd Ph Santa Monica CA 90401-1416 Ph: (310) 496-4277 | Dr Gabriel Crenshaw Clinical Psychologist Inc 401 Wilshire Blvd Ph Santa Monica CA 90401-1416 Ph: (310) 496-4277 |
| NPI Number | 1477225472 |
|---|---|
| Provider Enumeration Date | 09/29/2021 |
| Last Update Date | 09/29/2021 |
| Certification Date | 09/24/2021 |
| Medicare PECOS PAC ID | 4385035708 |
|---|---|
| Medicare Enrollment ID | O20211220000695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477225472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Gabriel Crenshaw |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679143945 PECOS PAC ID: 7911398334 Enrollment ID: I20211220000905 |
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