| Shannon K. Carter Psychologist, Inc. | |
|
608 N Avenue 50 Los Angeles CA 90042-3292 | |
| (323) 459-9642 | |
| Not Available |
| Full Name | Shannon K. Carter Psychologist, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 608 N Avenue 50, Los Angeles, California |
| Authorized Official Name and Position | Shannon Carter (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3234599642 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon K. Carter Psychologist, Inc. 716 N Priscilla Ln Burbank CA 91505-3138 Ph: (323) 459-9642 | Shannon K. Carter Psychologist, Inc. 608 N Avenue 50 Los Angeles CA 90042-3292 Ph: (323) 459-9642 |
| NPI Number | 1417572694 |
|---|---|
| Provider Enumeration Date | 06/12/2020 |
| Last Update Date | 09/06/2023 |
| Certification Date | 06/12/2020 |
| Medicare PECOS PAC ID | 0244655207 |
|---|---|
| Medicare Enrollment ID | O20200807001014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417572694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Shannon Kay Carter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811411614 PECOS PAC ID: 1153746110 Enrollment ID: I20200807001101 |
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