Provider Demographics
NPI:1447307947
Name:GRACE, GRETA HASSEL (LMFT)
Entity type:Individual
Prefix:MS
First Name:GRETA
Middle Name:HASSEL
Last Name:GRACE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ESSENCE INDIVIDUAL
Other - Middle Name:
Other - Last Name:AND MARRIAGE THERAPIST, INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MDIV
Mailing Address - Street 1:3811 EAST BLVD, #A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:310-818-1473
Mailing Address - Fax:
Practice Address - Street 1:3811 EAST BLVD
Practice Address - Street 2:#A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:310-818-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist