Healthcare Provider Details

I. General information

NPI: 1205758083
Provider Name (Legal Business Name): GLENDALE HAVEN CMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ARDEN AVE STE 110
GLENDALE CA
91203-1167
US

IV. Provider business mailing address

320 ARDEN AVE STE 110
GLENDALE CA
91203-1167
US

V. Phone/Fax

Practice location:
  • Phone: 818-287-1424
  • Fax:
Mailing address:
  • Phone: 818-287-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAMAM HARUTYUNYAN
Title or Position: CEO
Credential:
Phone: 818-287-1424