MEDICARE: THE GUIDED PATH PSYCHOLOGICAL SERVICES, PC

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	106H00000X	Marriage & Family Therapist
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1851108856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GUIDED PATH PSYCHOLOGICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	19348 COLLIER ST
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-3011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17000 VENTURA BLVD STE 210
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4153
Country	:	US
Telephone Number	:	818-427-4096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARJORIE BERBERIAN
Credential	:
Telephone Number	:	818-427-4096

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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