Healthcare Provider Details

I. General information

NPI: 1588249734
Provider Name (Legal Business Name): KARLY L MEOLA AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 W RIVERSIDE DR STE 400
BURBANK CA
91505-5301
US

IV. Provider business mailing address

3808 W RIVERSIDE DR STE 400
BURBANK CA
91505-5301
US

V. Phone/Fax

Practice location:
  • Phone: 323-942-9298
  • Fax:
Mailing address:
  • Phone: 323-942-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number117600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: