Provider Demographics
NPI:1538286588
Name:CO, EVELYN K (LMFT INC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:K
Last Name:CO
Suffix:
Gender:F
Credentials:LMFT INC
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:CO MFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EVELYN CO MFT
Mailing Address - Street 1:15714 HALLDALE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3842
Mailing Address - Country:US
Mailing Address - Phone:323-803-3131
Mailing Address - Fax:
Practice Address - Street 1:13323 W WASHINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5163
Practice Address - Country:US
Practice Address - Phone:800-803-4584
Practice Address - Fax:800-803-4584
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist