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General NPI Number Information
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NPI Number | 1851649271
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Entity Type | Individual
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Provider Name | CARLOS MANUEL LAACK LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 5747 LAUREL CANYON BLVD APT 32
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-1253
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Country | US
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Telephone | 805-214-8233
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Fax |
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Provider Business Mailing Address
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Address Line | 41 S WAKE FOREST AVE UNIT 3786
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City | VENTURA
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State | CA
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Zip | 93006-8039
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Country | US
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Telephone | 805-214-8233
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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 | 114823
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License Number State | CA
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