Provider Demographics
NPI:1194111203
Name:SPENCER, CAROL (LMFT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16944 VENTURA BLVD
Mailing Address - Street 2:24
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4144
Mailing Address - Country:US
Mailing Address - Phone:213-316-8576
Mailing Address - Fax:
Practice Address - Street 1:16944 VENTURA BLVD
Practice Address - Street 2:24
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4144
Practice Address - Country:US
Practice Address - Phone:213-316-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health