Provider Demographics
NPI:1750698056
Name:ELAINE S KARR PHD PROFESSIONAL CORP
Entity type:Organization
Organization Name:ELAINE S KARR PHD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-575-9332
Mailing Address - Street 1:11850 WILSHIRE BLVD
Mailing Address - Street 2:200A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6609
Mailing Address - Country:US
Mailing Address - Phone:310-575-9332
Mailing Address - Fax:310-575-9302
Practice Address - Street 1:11850 WILSHIRE BLVD
Practice Address - Street 2:200A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6609
Practice Address - Country:US
Practice Address - Phone:310-575-9332
Practice Address - Fax:310-575-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7488103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY074480Medicaid
CACP7488AMedicare UPIN