Basic Information
Provider Information
NPI: 1275040867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARST
FirstName: BRITNI
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1721 GRIFFIN AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900313312
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1721 GRIFFIN AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900313312
CountryCode: US
TelephoneNumber: 3232214134
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/04/2018
LastUpdateDate: 01/04/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X91575CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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