Provider Demographics
NPI:1164966719
Name:PICKEL, CARL THOMAS III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:THOMAS
Last Name:PICKEL
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12070 TELEGRAPH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-8213
Mailing Address - Country:US
Mailing Address - Phone:562-777-7503
Mailing Address - Fax:
Practice Address - Street 1:12070 TELEGRAPH RD STE 207
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-8213
Practice Address - Country:US
Practice Address - Phone:562-777-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW73714104100000X
CALCSW930411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker