=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346371754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSTITUTE FOR MULTICULTURAL COUNSELING AND EDUCATION SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 W LEXINGTON DR SUITE 300
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-240-4311
-----------------------------------------------------
Fax | 818-240-4318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 W LEXINGTON DR SUITE 300
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-240-4311
-----------------------------------------------------
Fax | 818-240-4318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. TAHEREH PIRHEKAYATY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 213-381-1250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | 960001451
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 960001451
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 960001451
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 960001451
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 960001451
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------