Healthcare Provider Details

I. General information

NPI: 1225551625
Provider Name (Legal Business Name): EDWARD BABAYAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 101
PASADENA CA
91107-6622
US

IV. Provider business mailing address

930 N LOUISE ST UNIT 204
GLENDALE CA
91207-2056
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-4055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: