=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427577659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAUTIFUL LIFE SERVICES, LICENSED CLINICAL SOCIAL WORKER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 09/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9700 RESEDA BLVD # 203
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-882-8776
-----------------------------------------------------
Fax | 818-882-8776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9700 RESEDA BLVD # 203
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. ARPE ASATURYAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 818-882-8776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 73400
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------