Healthcare Provider Details

I. General information

NPI: 1992181143
Provider Name (Legal Business Name): INGA SIMONIAN, PHD PSYCHOLOGY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W ALAMEDA AVE STE 103
BURBANK CA
91502-3023
US

IV. Provider business mailing address

209 W ALAMEDA AVE STE 103
BURBANK CA
91502-3023
US

V. Phone/Fax

Practice location:
  • Phone: 818-570-1636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberPSY25302
License Number StateCA

VIII. Authorized Official

Name: DR. INGA SIMONIAN
Title or Position: CEO
Credential: PHD
Phone: 818-570-1636