Individual
DR. GREGORY JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
10380 WILSHIRE BLVD APT 1103, LOS ANGELES, CA 90024-4756
(424) 788-0091
Mailing address
4 QUARTERDECK ST APT 1, MARINA DEL REY, CA 90292-6757
(310) 709-3541
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY35526
CA
Other
Enumeration date
03/24/2025
Last updated
03/24/2025
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