Provider Demographics
NPI:1811362023
Name:CARISSA KARNER
Entity Type:Organization
Organization Name:CARISSA KARNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT #90863
Authorized Official - Phone:818-331-9881
Mailing Address - Street 1:3900 E 11TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4114
Mailing Address - Country:US
Mailing Address - Phone:818-331-9881
Mailing Address - Fax:
Practice Address - Street 1:2124 MAIN ST STE 230
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-7456
Practice Address - Country:US
Practice Address - Phone:818-331-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty