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General NPI Number Information
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NPI Number | 1679102586
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Entity Type | Individual
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Provider Name | CAROL MCCALLISTER LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 2730 WILSHIRE BLVD STE 660
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City | SANTA MONICA
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State | CA
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Zip | 90403-4746
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Country | US
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Telephone | 310-963-4580
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Fax |
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Provider Business Mailing Address
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Address Line | 759 HAVERFORD AVE
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-4313
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Country | US
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Telephone | 310-963-4580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 53042
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License Number State | CA
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