Healthcare Provider Details

I. General information

NPI: 1033998257
Provider Name (Legal Business Name): HELEN TAVETIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15305 RAYEN ST
NORTH HILLS CA
91343-5117
US

IV. Provider business mailing address

1524 GRANVIA ALTAMIRA
PALOS VERDES ESTATES CA
90274-2133
US

V. Phone/Fax

Practice location:
  • Phone: 818-892-3423
  • Fax:
Mailing address:
  • Phone: 310-714-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: