Provider Demographics
NPI:1881710747
Name:MAGGIE A CARROLL MFT PHD
Entity type:Organization
Organization Name:MAGGIE A CARROLL MFT PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MFT PHD
Authorized Official - Phone:310-600-6561
Mailing Address - Street 1:9300 WILSHIRE BLVD
Mailing Address - Street 2:STE 306
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-600-6561
Mailing Address - Fax:310-276-4010
Practice Address - Street 1:9300 WILSHIRE BLVD
Practice Address - Street 2:STE 306
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-600-6561
Practice Address - Fax:310-276-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty