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General NPI Number Information
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NPI Number | 1245889906
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Entity Type | Organization
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Legal Business Name | CAROL KELSON, PH.D., MARRIAGE AND FAMILY THERAPIST, INC.
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 4221 WILSHIRE BLVD. SUITE 290-4
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City | LOS ANGELES
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State | CA
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Zip | 90010-3031
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Country | US
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Telephone | 310-909-4538
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Fax |
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Provider Business Mailing Address
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Address Line | 4221 WILSHIRE BLVD. SUITE 290-4
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City | LOS ANGELES
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State | CA
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Zip | 90010-3031
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Country | US
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Telephone | 310-909-4538
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROL YASUKO KELSON
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Credential | PH.D., LMFT
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Telephone | 310-909-4538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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