Healthcare Provider Details

I. General information

NPI: 1386205995
Provider Name (Legal Business Name): YELENA MATEVOSYAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date: 06/19/2026
Reactivation Date: 07/21/2026

III. Provider practice location address

10343 STRATHERN ST
SUN VALLEY CA
91352-4157
US

IV. Provider business mailing address

10343 STRATHERN ST
SUN VALLEY CA
91352-4157
US

V. Phone/Fax

Practice location:
  • Phone: 323-870-7770
  • Fax:
Mailing address:
  • Phone: 323-870-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: