Healthcare Provider Details

I. General information

NPI: 1437626488
Provider Name (Legal Business Name): THE KHACHATRYAN CORPORATION, LICENSED PROFESSIONAL CLINICAL COUNSELOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 05/31/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CAMINO DE LA REINA STE 210
SAN DIEGO CA
92108-3104
US

IV. Provider business mailing address

591 CAMINO DE LA REINA STE 210
SAN DIEGO CA
92108-3104
US

V. Phone/Fax

Practice location:
  • Phone: 619-206-5271
  • Fax: 619-795-3274
Mailing address:
  • Phone: 619-206-5271
  • Fax: 619-795-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TATEVIK KHACHATRYAN
Title or Position: PRESIDENT/CEO
Credential: MA
Phone: 619-206-5271