Healthcare Provider Details

I. General information

NPI: 1124618038
Provider Name (Legal Business Name): MR. MANOUEL OHANESYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E COLORADO ST STE 710
GLENDALE CA
91205-1675
US

IV. Provider business mailing address

425 E COLORADO ST STE 710
GLENDALE CA
91205-1675
US

V. Phone/Fax

Practice location:
  • Phone: 818-547-9544
  • Fax:
Mailing address:
  • Phone: 818-547-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT133477
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMT156259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: