Healthcare Provider Details

I. General information

NPI: 1689305120
Provider Name (Legal Business Name): ANANDITA BAHRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 W OLYMPIC BLVD STE 815E
LOS ANGELES CA
90064-5056
US

IV. Provider business mailing address

1615 WILCOX AVE # 2014
LOS ANGELES CA
90028-6205
US

V. Phone/Fax

Practice location:
  • Phone: 323-332-9905
  • Fax:
Mailing address:
  • Phone: 857-206-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23557
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: