Provider Demographics
NPI:1053758276
Name:HERNANDEZ, GISELLE M (AMFT)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 185TH ST
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4607
Mailing Address - Country:US
Mailing Address - Phone:310-803-7414
Mailing Address - Fax:
Practice Address - Street 1:4700 W. SUNSET BLVD.
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-783-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2023-10-16
Deactivation Date:2019-05-31
Deactivation Code:
Reactivation Date:2021-12-23
Provider Licenses
StateLicense IDTaxonomies
CAAMFT133731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health