Healthcare Provider Details

I. General information

NPI: 1316422942
Provider Name (Legal Business Name): CAROL M LAZO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WILSHIRE BLVD STE 204
SANTA MONICA CA
90401-1737
US

IV. Provider business mailing address

13389 FOLSOM BLVD. #200
FOLSOM CA
95630
US

V. Phone/Fax

Practice location:
  • Phone: 424-488-6422
  • Fax: 213-652-6332
Mailing address:
  • Phone: 424-488-6422
  • Fax: 213-652-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: