Healthcare Provider Details

I. General information

NPI: 1396265567
Provider Name (Legal Business Name): TIGRAN ALEXANIAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 10/09/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 750 RICE CANYON ROAD
SUSANVILLE CA
96130
US

IV. Provider business mailing address

475-750 RICE CANYON RD
SUSANVILLE CA
96127
US

V. Phone/Fax

Practice location:
  • Phone: 530-251-5100
  • Fax: 530-251-5017
Mailing address:
  • Phone: 530-251-5100
  • Fax: 530-251-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberUNLICENSED
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104248
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: