Provider Demographics
NPI:1104409135
Name:GROTHE, CAROLYN R (CA LMFT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:GROTHE
Suffix:
Gender:F
Credentials:CA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14757
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90853-4757
Mailing Address - Country:US
Mailing Address - Phone:310-820-6008
Mailing Address - Fax:
Practice Address - Street 1:1137 2ND ST STE 211
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5078
Practice Address - Country:US
Practice Address - Phone:310-820-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT8369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health