Healthcare Provider Details

I. General information

NPI: 1407130768
Provider Name (Legal Business Name): NANSI MANOKIAN M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N MARYLAND AVE SUITE 303
GLENDALE CA
91206-4261
US

IV. Provider business mailing address

230 N MARYLAND AVE SUITE 303
GLENDALE CA
91206-4261
US

V. Phone/Fax

Practice location:
  • Phone: 818-281-9157
  • Fax:
Mailing address:
  • Phone: 818-281-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number89488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: