Healthcare Provider Details

I. General information

NPI: 1649892654
Provider Name (Legal Business Name): JENNIFER MIRANDA MAHSEREDJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 SAINT ANDREWS PL
WESTLAKE VILLAGE CA
91362-4716
US

IV. Provider business mailing address

5743 CORSA AVE STE 125
WESTLAKE VILLAGE CA
91362-6462
US

V. Phone/Fax

Practice location:
  • Phone: 818-646-6733
  • Fax:
Mailing address:
  • Phone: 818-245-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT140264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: