MEDICARE: CHARLOTTE KAY LMFT

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
1	101YM0800X	Mental Health Counselor	MFC 82224	CA

General Provider Information

NPI Number	:	1942601489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE KAY LMFT

Provider Business Mailing Address
First Line	:	2820 GLENDALE BLVD # 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2723
Country	:	US
Telephone Number	:	323-825-1585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 GLENDALE BLVD STE 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2723
Country	:	US
Telephone Number	:	323-825-1585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	06/04/2024

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