Provider Demographics
NPI:1598999294
Name:CARLSON, CATHLEEN A (MFT)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:A
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18029 GLENBURN AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4033
Mailing Address - Country:US
Mailing Address - Phone:310-523-1930
Mailing Address - Fax:310-523-2020
Practice Address - Street 1:18029 GLENBURN AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4033
Practice Address - Country:US
Practice Address - Phone:310-523-1930
Practice Address - Fax:310-523-2020
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist