Carol Kelson, PH.D., Marriage and Family Therapist, Inc.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

CAROL KELSON, PH.D., MARRIAGE AND FAMILY THERAPIST, INC.

Doing business as

Advance Integrated Wellness

Practice address

4221 Wilshire Blvd.
Suite 290-4
Los Angeles, CA 90010-3031

Phone

(310) 909-4538

NPI assigned

Sep 5, 2019

Last updated

Sep 5, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carol Yasuko Kelson, PH.D., LMFTNPI 1689807190

Title

Owner

Phone

(310) 909-4538

Specialties & licenses 1

Addresses

Other names 1

• Advance Integrated Wellness Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carol Kelson, PH.D., LMFT

  • Marriage & Family Therapist
  • Los Angeles, CA
  • NPI 1689807190
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567641600000",
    "number": "1245889906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 WILSHIRE BLVD.",
            "address_2": "SUITE 290-4",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103031",
            "telephone_number": "310-909-4538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 WILSHIRE BLVD.",
            "address_2": "SUITE 290-4",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103031",
            "telephone_number": "310-909-4538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROL KELSON, PH.D., MARRIAGE AND FAMILY THERAPIST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-05",
        "last_updated": "2019-09-05",
        "status": "A",
        "authorized_official_last_name": "KELSON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "YASUKO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-909-4538",
        "authorized_official_credential": "PH.D., LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advance Integrated Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.