Healthcare Provider Details

I. General information

NPI: 1669086070
Provider Name (Legal Business Name): MARIANNA HOVSEPYAN AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15339 SATICOY ST
VAN NUYS CA
91406-3345
US

IV. Provider business mailing address

15339 SATICOY ST
VAN NUYS CA
91406-3345
US

V. Phone/Fax

Practice location:
  • Phone: 818-645-0004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT132778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: