MEDICARE: L.A. PSYCH

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	103T00000X	Psychologist	PSY 21883	CA

General Provider Information

NPI Number	:	1255603965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.A. PSYCH

Provider Business Mailing Address
First Line	:	11846 VENTURA BLVD STE 204
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2620
Country	:	US
Telephone Number	:	818-523-9394
Fax Number	:	818-286-9570

Provider Business Practice Location Address
First Line	:	11846 VENTURA BLVD STE 204
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2620
Country	:	US
Telephone Number	:	818-523-9394
Fax Number	:	818-286-9570

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. SHEYDA MIA MELKONIAN
Credential	:	PSY.D.
Telephone Number	:	818-523-9394

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2026

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