Healthcare Provider Details

I. General information

NPI: 1669130530
Provider Name (Legal Business Name): ELIZABETH KUCHAKHCHIAN MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15233 VENTURA BLVD STE 1208
SHERMAN OAKS CA
91403-2271
US

IV. Provider business mailing address

7100 BALBOA BLVD UNIT 807
LAKE BALBOA CA
91406-3637
US

V. Phone/Fax

Practice location:
  • Phone: 310-857-2277
  • Fax:
Mailing address:
  • Phone: 818-807-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT128954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: