=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801481601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPEN EXPRESSIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2021
-----------------------------------------------------
Last Update Date | 03/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18740 VENTURA BLVD STE 202
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-713-8841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 S PARISH PL
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-713-8841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICIAN
-----------------------------------------------------
Name | MRS. INNESA RCHTOUNI
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 323-713-8841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------