Provider Demographics
NPI:1396065785
Name:CARLSON, KIMBERLY HELEN (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HELEN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2709
Mailing Address - Country:US
Mailing Address - Phone:323-660-0028
Mailing Address - Fax:
Practice Address - Street 1:4448 AMBROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2115
Practice Address - Country:US
Practice Address - Phone:323-350-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist