=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790809192
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALENOUSH BEDROSSIAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 05/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N BRAND BLVD STE 206
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-634-5984
-----------------------------------------------------
Fax | 818-539-2204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N BRAND BLVD STE 206
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-634-5984
-----------------------------------------------------
Fax | 818-539-2204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 46054
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------