Healthcare Provider Details

I. General information

NPI: 1902941990
Provider Name (Legal Business Name): CHARLES SCOTT MUSGROVE PSYD, MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7162 BEVERLY BLVD # 343
LOS ANGELES CA
90036-2547
US

IV. Provider business mailing address

7162 BEVERLY BLVD # 343
LOS ANGELES CA
90036-2547
US

V. Phone/Fax

Practice location:
  • Phone: 323-401-2972
  • Fax:
Mailing address:
  • Phone: 323-401-2972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number24293
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48498
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: