Healthcare Provider Details

I. General information

NPI: 1851108856
Provider Name (Legal Business Name): THE GUIDED PATH PSYCHOLOGICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 VENTURA BLVD STE 210
ENCINO CA
91316-4153
US

IV. Provider business mailing address

19348 COLLIER ST
TARZANA CA
91356-3011
US

V. Phone/Fax

Practice location:
  • Phone: 818-427-4096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARJORIE BERBERIAN
Title or Position: OWNER
Credential:
Phone: 818-427-4096