Healthcare Provider Details

I. General information

NPI: 1194358978
Provider Name (Legal Business Name): INVICTA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 LAKE AVE STE 110
ALTADENA CA
91001-6002
US

IV. Provider business mailing address

2235 LAKE AVE STE 110
ALTADENA CA
91001-6002
US

V. Phone/Fax

Practice location:
  • Phone: 626-786-4864
  • Fax:
Mailing address:
  • Phone: 626-786-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ARMAN TER-GRIGORYAN
Title or Position: PRESIDENT
Credential: LMFT
Phone: 626-786-4864