Provider Demographics
NPI:1215294871
Name:HANKS, KARLA MAUREEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KARLA
Middle Name:MAUREEN
Last Name:HANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7692 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1636
Mailing Address - Country:US
Mailing Address - Phone:714-417-2220
Mailing Address - Fax:310-634-1991
Practice Address - Street 1:6820 LA TIJERA BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1908
Practice Address - Country:US
Practice Address - Phone:714-417-2220
Practice Address - Fax:310-634-1991
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS15519101YM0800X, 104100000X, 1041C0700X, 1041S0200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGJ897AMedicare PIN