Provider Demographics
NPI:1962659169
Name:SPAHN, CHARLES TYLER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:TYLER
Last Name:SPAHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:TYLER
Other - Last Name:SPAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1910 W SUNSET BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3262
Mailing Address - Country:US
Mailing Address - Phone:213-437-3155
Mailing Address - Fax:
Practice Address - Street 1:3303 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2803
Practice Address - Country:US
Practice Address - Phone:323-478-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW605461041C0700X, 1041C0700X
CAASW #28484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health