Provider Demographics
NPI:1942710116
Name:ELKINS, CARLA SANTULLI (LMFT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SANTULLI
Last Name:ELKINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2461
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28328 AGOURA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AGOURA
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:310-994-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist