Healthcare Provider Details

I. General information

NPI: 1720855455
Provider Name (Legal Business Name): CAREY LOUDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 N MARENGO AVE
PASADENA CA
91103-2217
US

IV. Provider business mailing address

1000 W 8TH ST
LOS ANGELES CA
90017-5946
US

V. Phone/Fax

Practice location:
  • Phone: 817-889-1213
  • Fax:
Mailing address:
  • Phone: 817-889-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: