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NPI Code Detail

MEDICARE: EVELYN K CO LMFT INC

MEDICARE: EVELYN K CO LMFT INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 44330CA

General Provider Information

NPI Number : 1538286588
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN K CO LMFT INC
Provider Business Mailing Address
First Line : 15714 HALLDALE AVE APT B
Second Line :
City : GARDENA
State : CA
Zip : 90247-3842
Country : US
Telephone Number : 323-803-3131
Fax Number :
Provider Business Practice Location Address
First Line : 13323 W WASHINGTON BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5163
Country : US
Telephone Number : 800-803-4584
Fax Number : 800-803-4584
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 09/29/2023

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Directions to “ EVELYN K CO LMFT INC” Practice Location

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