Provider Demographics
NPI:1992243877
Name:KASSASEYA, GABRIEL GEORGE
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:GEORGE
Last Name:KASSASEYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W SUNSET BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6070
Mailing Address - Country:US
Mailing Address - Phone:323-783-7318
Mailing Address - Fax:
Practice Address - Street 1:4700 W SUNSET BLVD FL 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6070
Practice Address - Country:US
Practice Address - Phone:323-783-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7948101YP2500X
CA110344106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional