Healthcare Provider Details

I. General information

NPI: 1275496168
Provider Name (Legal Business Name): LORI A TAKVORIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 SHERMAN CIR
VAN NUYS CA
91405-3087
US

IV. Provider business mailing address

6263 TOPANGA CANYON BLVD
WOODLAND HILLS CA
91367-8060
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4879
  • Fax:
Mailing address:
  • Phone: 818-331-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: