Healthcare Provider Details

I. General information

NPI: 1790809192
Provider Name (Legal Business Name): ALENOUSH BEDROSSIAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRAND BLVD STE 206
GLENDALE CA
91203-2641
US

IV. Provider business mailing address

100 N BRAND BLVD STE 206
GLENDALE CA
91203-2641
US

V. Phone/Fax

Practice location:
  • Phone: 818-634-5984
  • Fax: 818-539-2204
Mailing address:
  • Phone: 818-634-5984
  • Fax: 818-539-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: