Healthcare Provider Details

I. General information

NPI: 1891928743
Provider Name (Legal Business Name): KAREN SPOOR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W GRAND AVE
EL SEGUNDO CA
90245-3713
US

IV. Provider business mailing address

2200 PACIFIC COAST HIGHWAY SUITE 306
HERMOSA BEACH CA
90254-2702
US

V. Phone/Fax

Practice location:
  • Phone: 310-765-0146
  • Fax: 310-426-9846
Mailing address:
  • Phone: 310-765-0146
  • Fax: 310-426-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY22879
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number22879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: