Healthcare Provider Details

I. General information

NPI: 1346857638
Provider Name (Legal Business Name): JEREMY BARKEV TOVMASSIAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLOVIS AVE STE 204
CLOVIS CA
93612-1167
US

IV. Provider business mailing address

4911 W GRACE ST
CHICAGO IL
60641-3506
US

V. Phone/Fax

Practice location:
  • Phone: 818-261-7116
  • Fax:
Mailing address:
  • Phone: 818-261-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: