Healthcare Provider Details

I. General information

NPI: 1104122704
Provider Name (Legal Business Name): ANET KHECHOUMIAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 E 4TH STREET SUITE 3
LONG BEACH CA
90802-2606
US

IV. Provider business mailing address

731 E 4TH STREET SUITE 3
LONG BEACH CA
90802-2606
US

V. Phone/Fax

Practice location:
  • Phone: 818-521-0602
  • Fax:
Mailing address:
  • Phone: 818-521-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT88926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT88926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: