| Carlson Psychotherapy Services Inc. | |
|
2810 E Del Mar Blvd Ste 12 Pasadena CA 91107-6709 | |
| (626) 585-0041 | |
| Not Available |
| Full Name | Carlson Psychotherapy Services Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2810 E Del Mar Blvd Ste 12, Pasadena, California |
| Authorized Official Name and Position | Wendy Carlson (OWNER/CEO) |
| Authorized Official Contact | 6264214630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlson Psychotherapy Services Inc. 2810 E Del Mar Blvd Ste 12 Pasadena CA 91107-6709 Ph: (626) 585-0041 | Carlson Psychotherapy Services Inc. 2810 E Del Mar Blvd Ste 12 Pasadena CA 91107-6709 Ph: (626) 585-0041 |
| NPI Number | 1255967212 |
|---|---|
| Provider Enumeration Date | 03/20/2020 |
| Last Update Date | 03/20/2020 |
| Certification Date | 03/20/2020 |
| Medicare PECOS PAC ID | 5294164497 |
|---|---|
| Medicare Enrollment ID | O20200409002827 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255967212 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Wendy L Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073149027 PECOS PAC ID: 6103255302 Enrollment ID: I20200409003074 |
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