Basic Information
Provider Information | |||||||||
NPI: | 1245364322 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KARSPECK | ||||||||
FirstName: | ARELLA | ||||||||
MiddleName: | LYDIA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.F.T.I. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 512 S EUCLID AVE | ||||||||
Address2: | UNIT # 6 | ||||||||
City: | PASADENA | ||||||||
State: | CA | ||||||||
PostalCode: | 911013264 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6263542584 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 12450 VAN NUYS BLVD | ||||||||
Address2: | SUITE 100 | ||||||||
City: | PACOIMA | ||||||||
State: | CA | ||||||||
PostalCode: | 913311391 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8188968366 | ||||||||
FaxNumber: | 8188968392 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2007 | ||||||||
LastUpdateDate: | 07/11/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X |   |   | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.