Healthcare Provider Details

I. General information

NPI: 1013833516
Provider Name (Legal Business Name): MARTHA TO MARY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 455H
GARDENA CA
90248-4320
US

IV. Provider business mailing address

1225 W 190TH ST STE 455H
GARDENA CA
90248-4320
US

V. Phone/Fax

Practice location:
  • Phone: 310-800-9011
  • Fax:
Mailing address:
  • Phone: 310-800-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARLA CALLAWAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 310-800-9011