MEDICARE: MISS MARY BAKCHACHYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1457776775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY BAKCHACHYAN

Provider Business Mailing Address
First Line	:	1933 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4501
Country	:	US
Telephone Number	:	213-763-3157
Fax Number	:	213-742-7011

Provider Business Practice Location Address
First Line	:	1933 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4501
Country	:	US
Telephone Number	:	213-763-3157
Fax Number	:	213-742-7011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	02/24/2014

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Directions to “ MISS MARY BAKCHACHYAN ” Practice Location

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