Provider Demographics
NPI:1316125776
Name:GRESARD, CECILE MARIE (MFT)
Entity type:Individual
Prefix:MRS
First Name:CECILE
Middle Name:MARIE
Last Name:GRESARD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 CLOVERFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-5226
Mailing Address - Country:US
Mailing Address - Phone:310-597-9973
Mailing Address - Fax:
Practice Address - Street 1:2121 CLOVERFIELD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-5226
Practice Address - Country:US
Practice Address - Phone:310-597-9973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALIC # MFC 43618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist