Provider Demographics
NPI:1679143945
Name:CRENSHAW, GABRIEL JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:CRENSHAW
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WILSHIRE BLVD PH SUITE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1416
Mailing Address - Country:US
Mailing Address - Phone:310-251-9428
Mailing Address - Fax:
Practice Address - Street 1:401 WILSHIRE BLVD PH SUITE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1416
Practice Address - Country:US
Practice Address - Phone:310-496-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherI DON'T HAVE SUCH NUMBERS.