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General NPI Number Information
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NPI Number | 1730940115
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Entity Type | Organization
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Legal Business Name | EVELYN CO LICENSE MARRIAGE AND FAMILY THERAPIST INC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 13323 W WASHINGTON BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90066-5163
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Country | US
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Telephone | 800-803-4584
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Fax | 800-803-4584
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Provider Business Mailing Address
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Address Line | 15714 HALLDALE AVE APT B
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City | GARDENA
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State | CA
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Zip | 90247-3842
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Country | US
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Telephone | 800-803-4584
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Fax | 800-803-4584
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Authorized Official
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Title or Position | CEO
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Name | MS. EVELYN CO
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Credential | LMFT
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Telephone | 323-803-3131
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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