Healthcare Provider Details

I. General information

NPI: 1376687806
Provider Name (Legal Business Name): YVETTE BAHARYANS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date: BAHARYANS YVETTE 1141 N COLUMBUS AVE APT 206 GLENDALE CA 91202 66 HURLBUT PASADENA CA 91105
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HURLBUT
PASADENA CA
91105
US

IV. Provider business mailing address

1141 N COLUMBUS AVE APT 206
GLENDALE CA
91202-3247
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4221
  • Fax:
Mailing address:
  • Phone: 818-269-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: