Provider Demographics
NPI:1942719091
Name:CARRUTH, JAMIE LAUREN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LAUREN
Last Name:CARRUTH
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 1:3361 GLENDALE BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1825
Mailing Address - Country:US
Mailing Address - Phone:1424-248-7986
Mailing Address - Fax:
Practice Address - Street 1:3361 GLENDALE BLVD FL 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1825
Practice Address - Country:US
Practice Address - Phone:1424-248-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist