# GENDERLAB, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GenderLab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104589738
- **Authorized official:** JAMES JASPER GRIMM (CEO)
- **Authorized official phone:** (310) 606-1905

## Contact information

- **Practice address:** 2043 CALIFORNIA 2, WRIGHTWOOD, CA 92397-3274
- **Practice address phone:** (310) 606-1905
- **Mailing address:** PO BOX 3274, WRIGHTWOOD, CA 92397-3274
- **Mailing address phone:** (310) 606-1905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 10/20/2021
- **Last updated:** 11/09/2023