Provider Demographics
NPI:1952020794
Name:CARLSON, DAVID SCOTT (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2709
Mailing Address - Country:US
Mailing Address - Phone:323-350-8858
Mailing Address - Fax:
Practice Address - Street 1:4344 FOUNTAIN AVE STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-4344
Practice Address - Country:US
Practice Address - Phone:323-350-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT131736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist