Provider Demographics
NPI:1861110827
Name:MATTOX, GRETCHEN (LMFT)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MATTOX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 COLD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2204
Mailing Address - Country:US
Mailing Address - Phone:310-612-8590
Mailing Address - Fax:
Practice Address - Street 1:479 COLD CANYON RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2204
Practice Address - Country:US
Practice Address - Phone:310-621-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist