MEDICARE: NICOLE JABOURIAN LICENSED MARRIAGE AND FAMILY THERAPY, INCORPORATION

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1912898099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE JABOURIAN LICENSED MARRIAGE AND FAMILY THERAPY, INCORPORATION

Provider Business Mailing Address
First Line	:	213 N GLENDALE AVE # 1035
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E WALNUT ST STE 260
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1800
Country	:	US
Telephone Number	:	818-495-5775
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	NICOLE JABOURIAN
Credential	:
Telephone Number	:	818-495-5775

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	07/15/2025

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