Basic Information
| Provider Information | |||||||||
| NPI: | 1023398245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHATAN | ||||||||
| FirstName: | BITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5554 RESEDA BLVD. | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913564162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187055522 | ||||||||
| FaxNumber: | 8187050522 | ||||||||
| Practice Location | |||||||||
| Address1: | 5554 RESEDA BLVD. | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913564162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187055522 | ||||||||
| FaxNumber: | 8187050522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2011 | ||||||||
| LastUpdateDate: | 04/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1234 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.