Healthcare Provider Details

I. General information

NPI: 1104208131
Provider Name (Legal Business Name): ARDITH EDEN BIACAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 ATLANTIC AVE STE 210
LONG BEACH CA
90807-4569
US

IV. Provider business mailing address

8616 LA TIJERA BLVD STE 200
LOS ANGELES CA
90045-3945
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-1886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number68826
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: