Provider Demographics
NPI:1083733562
Name:CAROLL, JOYCE ELLEN (MFT)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:ELLEN
Last Name:CAROLL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PLAIN TRL
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3651
Mailing Address - Country:US
Mailing Address - Phone:310-455-0402
Mailing Address - Fax:
Practice Address - Street 1:11925 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6618
Practice Address - Country:US
Practice Address - Phone:310-569-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist