Organization
NICOLE GERSHENSON MARRIAGE AND FAMILY THERAPIST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE GERSHENSON (OWNER)
(818) 401-8889
Entity
Organization
Contact information
Practice address
5535 BALBOA BLVD STE 202, ENCINO, CA 91316-1541
(818) 401-8889
(818) 330-4206
Mailing address
5535 BALBOA BLVD STE 202, ENCINO, CA 91316-1541
(818) 401-8889
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
01/22/2021
Last updated
01/22/2021
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