Provider Demographics
NPI:1093131799
Name:KORN, CARLA E (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:E
Last Name:KORN
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 1:30423 CANWOOD ST STE 129
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4315
Mailing Address - Country:US
Mailing Address - Phone:818-584-1021
Mailing Address - Fax:
Practice Address - Street 1:30423 CANWOOD ST STE 129
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4315
Practice Address - Country:US
Practice Address - Phone:818-584-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001092106H00000X
CA97312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist