Healthcare Provider Details

I. General information

NPI: 1033681903
Provider Name (Legal Business Name): LORY KHOUDIKIAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
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: 818-484-2991
Mailing address:
  • Phone: 818-945-0835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5859
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: