Healthcare Provider Details

I. General information

NPI: 1518584002
Provider Name (Legal Business Name): UPLIFT THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 VERDUGO BLVD STE D
LA CANADA CA
91011-3024
US

IV. Provider business mailing address

300 W GLENOAKS BLVD STE 304
GLENDALE CA
91202-3607
US

V. Phone/Fax

Practice location:
  • Phone: 818-864-6602
  • Fax:
Mailing address:
  • Phone: 818-245-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TALIN YACOUBIAN
Title or Position: OWNER
Credential: OTD
Phone: 818-245-5028