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General NPI Number Information
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NPI Number | 1902761851
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Entity Type | Organization
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Legal Business Name | SO THERAPY LA
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 4521 SHERMAN OAKS AVE STE 101
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3807
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Country | US
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Telephone | 747-777-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 15030 VENTURA BLVD # 673
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-5470
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Country | US
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Telephone | 747-777-3818
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. IRENE YAYMADJIAN
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Credential | PSYD
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Telephone | 747-777-3818
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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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