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General NPI Number Information
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NPI Number | 1396502951
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Entity Type | Organization
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Legal Business Name | A.D. INDIVIDUAL MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 15233 VENTURA BLVD STE 1125
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2246
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Country | US
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Telephone | 661-524-9938
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Fax | 661-524-9950
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Provider Business Mailing Address
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Address Line | 7300 WHITE OAK AVE
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City | VAN NUYS
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State | CA
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Zip | 91406-2347
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Country | US
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Telephone | 661-524-9938
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Fax | 661-524-9950
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Authorized Official
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Title or Position | OWNER
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Name | ANI DATASTANYAN
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Credential | LMFT
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Telephone | 661-524-9938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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