Healthcare Provider Details

I. General information

NPI: 1861854309
Provider Name (Legal Business Name): IRENE YAYMADJIAN PSYD. LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 01/23/2025
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 SHERMAN OAKS AVE. SUITE 101
SHERMAN OAKS CA
91403
US

IV. Provider business mailing address

4521 SHERMAN OAKS AVE. SUITE 101
SHERMAN OAKS CA
91403
US

V. Phone/Fax

Practice location:
  • Phone: 747-777-3818
  • Fax:
Mailing address:
  • Phone: 818-261-7486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT103952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: