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General NPI Number Information
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NPI Number | 1730583881
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Entity Type | Organization
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Legal Business Name | CAROL L. MEYLAN
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1600 ROSECRANS AVE SUITE 400
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-3708
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Country | US
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Telephone | 310-795-8249
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Fax |
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Provider Business Mailing Address
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Address Line | 514 VIA DE LA PAZ
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-4362
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Country | US
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Telephone | 310-795-8249
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. CAROL L MEYLAN
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Credential | LCSW
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Telephone | 310-795-8249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 28422
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License Number State | CA
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