Healthcare Provider Details

I. General information

NPI: 1972047058
Provider Name (Legal Business Name): AREEN BOLOUS-OWHADI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N LAKE AVE STE 150
PASADENA CA
91104-2388
US

IV. Provider business mailing address

2629 FOOTHILL BLVD # 184
LA CRESCENTA CA
91214-3511
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-1161
  • Fax:
Mailing address:
  • Phone: 818-797-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA041621021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: