Healthcare Provider Details

I. General information

NPI: 1992582233
Provider Name (Legal Business Name): LNK FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CENTRAL AVE # 311
GLENDALE CA
91202-2937
US

IV. Provider business mailing address

PO BOX 287
LA CANADA FLINTRIDGE CA
91012-0287
US

V. Phone/Fax

Practice location:
  • Phone: 818-945-0835
  • Fax: 855-595-2909
Mailing address:
  • Phone: 818-245-1155
  • Fax: 855-595-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LORY KHOUDIKIAN
Title or Position: OWNER/CEO
Credential: LMFT
Phone: 818-245-1155