Provider Demographics
NPI:1265254056
Name:ACKERMAN, CARLY (LMFT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 GRIFFITH PARK BLVD # 155
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2520
Mailing Address - Country:US
Mailing Address - Phone:909-293-9171
Mailing Address - Fax:
Practice Address - Street 1:2658 GRIFFITH PARK BLVD # 155
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2520
Practice Address - Country:US
Practice Address - Phone:909-293-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148733106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist