MEDICARE: TALIN KHECHOOMIAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	89129	CA

General Provider Information

NPI Number	:	1114467156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIN KHECHOOMIAN LCSW

Provider Business Mailing Address
First Line	:	11005 KITTRIDGE ST APT 101
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2761
Country	:	US
Telephone Number	:	747-977-1674
Fax Number	:

Provider Business Practice Location Address
First Line	:	11005 KITTRIDGE ST APT 101
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2761
Country	:	US
Telephone Number	:	747-977-1674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	01/15/2026

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