Provider Demographics
NPI:1972818813
Name:PRATT, JODY MARIE (MFT)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:MARIE
Last Name:PRATT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:MARIE
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:200 N SAN FERNANDO RD
Mailing Address - Street 2:UNIT 319
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1339
Mailing Address - Country:US
Mailing Address - Phone:602-502-9982
Mailing Address - Fax:
Practice Address - Street 1:1000 GOODRICH BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5103
Practice Address - Country:US
Practice Address - Phone:323-832-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist