Healthcare Provider Details

I. General information

NPI: 1124811146
Provider Name (Legal Business Name): ANJALI L ACHARYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 TERMINO AVE STE 105
LONG BEACH CA
90804-2126
US

IV. Provider business mailing address

PO BOX 4403
ORANGE CA
92863-4403
US

V. Phone/Fax

Practice location:
  • Phone: 562-999-2723
  • Fax:
Mailing address:
  • Phone: 657-900-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: