Provider Demographics
NPI:1316770753
Name:ELIZABETH CARR FAMILY THERAPY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ELIZABETH CARR FAMILY THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:310-717-2838
Mailing Address - Street 1:10845 BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2201
Mailing Address - Country:US
Mailing Address - Phone:310-717-2838
Mailing Address - Fax:
Practice Address - Street 1:4405 W RIVERSIDE DR STE 205
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4050
Practice Address - Country:US
Practice Address - Phone:310-717-2838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty