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General NPI Number Information
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NPI Number | 1417572694
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Entity Type | Organization
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Legal Business Name | SHANNON K. CARTER PSYCHOLOGIST, INC.
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 608 N AVENUE 50
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City | LOS ANGELES
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State | CA
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Zip | 90042-3292
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Country | US
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Telephone | 323-459-9642
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Fax |
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Provider Business Mailing Address
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Address Line | 716 N PRISCILLA LN
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City | BURBANK
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State | CA
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Zip | 91505-3138
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Country | US
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Telephone | 323-459-9642
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. SHANNON CARTER
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Credential | PSYD
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Telephone | 323-459-9642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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