Provider Demographics
NPI:1841570165
Name:CARLSON, JEFFREY PAUL (MFT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PAUL
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 VALLEY VIEW AVE
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5830
Mailing Address - Country:US
Mailing Address - Phone:714-994-0500
Mailing Address - Fax:714-994-0515
Practice Address - Street 1:16700 VALLEY VIEW AVE
Practice Address - Street 2:SUITE # 210
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5830
Practice Address - Country:US
Practice Address - Phone:714-994-0500
Practice Address - Fax:714-994-0515
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist