Provider Demographics
NPI:1962260513
Name:MICHAEL GREY MARRIAGE AND FAMILY THERAPIST INC.
Entity type:Organization
Organization Name:MICHAEL GREY MARRIAGE AND FAMILY THERAPIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:714-975-8893
Mailing Address - Street 1:2160 BARRANCA PKWY # 1419
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-4940
Mailing Address - Country:US
Mailing Address - Phone:714-975-8893
Mailing Address - Fax:
Practice Address - Street 1:4010 WATSON PLAZA DR
Practice Address - Street 2:STE 100
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:714-975-8893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty