1144572884 NPI number — MRS. HELEN KHALA HOVSEPIAN L.MFT

Table of content: MRS. HELEN KHALA HOVSEPIAN L.MFT (NPI 1144572884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144572884 NPI number — MRS. HELEN KHALA HOVSEPIAN L.MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHALA HOVSEPIAN
Provider First Name:
HELEN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144572884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 N. CENTRAL AVE.
Provider Second Line Business Mailing Address:
ST 600
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-922-0988
Provider Business Mailing Address Fax Number:
818-502-0508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9911 W. PICO BLVD.
Provider Second Line Business Practice Location Address:
ST 1480
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-922-0988
Provider Business Practice Location Address Fax Number:
818-502-0508
Provider Enumeration Date:
10/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC-49793 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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