Healthcare Provider Details

I. General information

NPI: 1265358378
Provider Name (Legal Business Name): PHANTOM PSYCHOLOGY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 VAN NUYS BLVD STE 202
SHERMAN OAKS CA
91403-1717
US

IV. Provider business mailing address

2155 VERDUGO BLVD # 130
MONTROSE CA
91020-1628
US

V. Phone/Fax

Practice location:
  • Phone: 818-281-3411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROCHELLE KARAPETIAN
Title or Position: PRESIDENT
Credential: PSYD
Phone: 818-281-3411