=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740437979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIKRAN AYARIAN MFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2008
-----------------------------------------------------
Last Update Date | 08/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3223 BAGLEY AVE SUITE NUMBER 209
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90034-2970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-876-0128
-----------------------------------------------------
Fax | 310-815-9770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3223 BAGLEY AVE SUITE NUMBER 209
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90034-2970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-876-0128
-----------------------------------------------------
Fax | 310-815-9770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 3053
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------