Healthcare Provider Details

I. General information

NPI: 1851923262
Provider Name (Legal Business Name): MELODY HOVSEPIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28494 WESTINGHOUSE PL STE 213
VALENCIA CA
91355-0934
US

IV. Provider business mailing address

1143 RAYMOND AVE APT C
GLENDALE CA
91201-4903
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-8200
  • Fax:
Mailing address:
  • Phone: 818-404-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT117400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: