Provider Demographics
NPI:1114783594
Name:PERLO, EVAN (MA, LMFT, CGP)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:PERLO
Suffix:
Gender:M
Credentials:MA, LMFT, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11970 MONTANA AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5021
Mailing Address - Country:US
Mailing Address - Phone:323-591-4841
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 215
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5385
Practice Address - Country:US
Practice Address - Phone:323-591-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist