Provider Demographics
NPI:1255570305
Name:LEROSE, KARA (MA, MFT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:LEROSE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WESTLAKE BLVD
Mailing Address - Street 2:#200
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2902
Mailing Address - Country:US
Mailing Address - Phone:818-986-9992
Mailing Address - Fax:818-889-4429
Practice Address - Street 1:875 WESTLAKE BLVD
Practice Address - Street 2:#200
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2902
Practice Address - Country:US
Practice Address - Phone:818-986-9992
Practice Address - Fax:818-889-4429
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT34895106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist